Healthcare Provider Details

I. General information

NPI: 1013003524
Provider Name (Legal Business Name): OXFORD PEDIATRICS & ADOLESCENTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10058 COOLEY RD
BROOKVILLE IN
47012
US

IV. Provider business mailing address

5141 MORNING SUN RD
OXFORD OH
45056
US

V. Phone/Fax

Practice location:
  • Phone: 765-647-2681
  • Fax: 765-647-3047
Mailing address:
  • Phone: 513-523-2156
  • Fax: 513-523-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLEN BUERK
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 513-523-2156