Healthcare Provider Details

I. General information

NPI: 1932142734
Provider Name (Legal Business Name): LINDA M. HERMILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA M. HERMILLER-STELLER MD

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 JAMES SIMPSON JR WAY SUITE 301
COVINGTON KY
41011-0801
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-8910
  • Fax: 859-655-8911
Mailing address:
  • Phone: 859-655-8910
  • Fax: 859-655-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number39613
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number39613
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: