Healthcare Provider Details

I. General information

NPI: 1437245644
Provider Name (Legal Business Name): ELLEN PLUMMER BUERK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 MORNING SUN RD
OXFORD OH
45056
US

IV. Provider business mailing address

5141 MORNING SUN RD
OXFORD OH
45056
US

V. Phone/Fax

Practice location:
  • Phone: 513-523-2156
  • Fax: 513-523-2503
Mailing address:
  • Phone: 513-523-2156
  • Fax: 513-523-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35030957
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01031865A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: