Healthcare Provider Details

I. General information

NPI: 1104965433
Provider Name (Legal Business Name): KATHERINE M BRADY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 JAGER CT
CINCINNATI OH
45230-4344
US

IV. Provider business mailing address

644 POLO FIELDS DRIVE
CINCINNATI OH
45244
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-8100
  • Fax: 513-232-3875
Mailing address:
  • Phone: 513-248-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35088215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: