Healthcare Provider Details

I. General information

NPI: 1770719239
Provider Name (Legal Business Name): AUDRA JOLYN HILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # A81
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # A81
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-2358
  • Fax:
Mailing address:
  • Phone: 216-445-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number121153
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116021246
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number9801162-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: