Healthcare Provider Details

I. General information

NPI: 1982767562
Provider Name (Legal Business Name): HYDE PARK PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 ERIE AVE SUITE 11
CINCINNATI OH
45208-1656
US

IV. Provider business mailing address

3330 ERIE AVE SUITE 11
CINCINNATI OH
45208-1656
US

V. Phone/Fax

Practice location:
  • Phone: 513-321-0199
  • Fax: 513-321-0301
Mailing address:
  • Phone: 513-321-0199
  • Fax: 513-321-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KASEY MACKE
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 513-321-0199