Healthcare Provider Details

I. General information

NPI: 1801962493
Provider Name (Legal Business Name): MICHAEL THOMAS DEE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 CLOUGH PIKE
CINCINNATI OH
45244-4053
US

IV. Provider business mailing address

560 S LOOP RD
EDGEWOOD KY
41017-3405
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-2663
  • Fax: 859-817-7848
Mailing address:
  • Phone: 859-301-2663
  • Fax: 859-817-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50 002521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: