Healthcare Provider Details

I. General information

NPI: 1275996670
Provider Name (Legal Business Name): KATHERINE AMELIA MUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE AMELIA HELMUTH MD

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N FAIRFIELD RD. 120
BEAVERCREEK OH
45432-4543
US

IV. Provider business mailing address

PO BOX 933432
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-320-8888
  • Fax: 937-320-3848
Mailing address:
  • Phone: 937-641-5072
  • Fax: 937-641-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number151564
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.137151
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: