Healthcare Provider Details

I. General information

NPI: 1427052075
Provider Name (Legal Business Name): MATTHEW BIRKLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 11/27/2023
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6139 GLENWAY AVE
CINCINNATI OH
45211-6312
US

IV. Provider business mailing address

6739 STATE ROUTE 128 P.O BOX 189
MIAMITOWN OH
45041-0189
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-3399
  • Fax: 513-852-1467
Mailing address:
  • Phone: 513-923-2623
  • Fax: 513-852-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35069240
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01059348A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: