MEDICARE: ERIKA D BRUDZINSKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	86180	OH
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	86180	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000488408	OTHER	OH	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093787160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA D BRUDZINSKI MD

Provider Business Mailing Address
First Line	:	11500 NORTHLAKE DR STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1658
Country	:	US
Telephone Number	:	513-742-6310
Fax Number	:	513-742-6318

Provider Business Practice Location Address
First Line	:	11500 NORTHLAKE DR STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1658
Country	:	US
Telephone Number	:	513-742-6310
Fax Number	:	513-742-6318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	12/02/2019

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