MEDICARE: MADISON KAYE OAKES-DUTKEVITCH

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	50.007821RX	OH

General Provider Information

NPI Number	:	1396488748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON KAYE OAKES-DUTKEVITCH

Provider Business Mailing Address
First Line	:	1430 OAK CT STE 100
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45430-1064
Country	:	US
Telephone Number	:	937-404-1101
Fax Number	:	937-404-1210

Provider Business Practice Location Address
First Line	:	8459 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-3938
Country	:	US
Telephone Number	:	434-944-0053
Fax Number	:

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

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	12/11/2024

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