Healthcare Provider Details

I. General information

NPI: 1689202061
Provider Name (Legal Business Name): HILEY CAMMOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 LUDLOW AVE APT 10
CINCINNATI OH
45220-2031
US

IV. Provider business mailing address

359 LUDLOW AVE APT 10
CINCINNATI OH
45220-2031
US

V. Phone/Fax

Practice location:
  • Phone: 605-660-7792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1027724
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: