Healthcare Provider Details

I. General information

NPI: 1265993315
Provider Name (Legal Business Name): KELSEY LAUREL SADDORIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 5018
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE ML 6015
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4315
  • Fax:
Mailing address:
  • Phone: 513-636-0800
  • Fax: 513-803-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.149218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: