Provider Demographics
NPI:1447447651
Name:CARLOS M ONGKIKO JR MD INC
Entity type:Organization
Organization Name:CARLOS M ONGKIKO JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ONGKIKO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:513-422-3251
Mailing Address - Street 1:210 S BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5157
Mailing Address - Country:US
Mailing Address - Phone:513-422-3251
Mailing Address - Fax:513-422-0305
Practice Address - Street 1:210 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5157
Practice Address - Country:US
Practice Address - Phone:513-422-3251
Practice Address - Fax:513-422-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3018111Medicaid
OH3018111Medicaid
OH0369340001Medicare NSC