MEDICARE: MITCHELL EDE, MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609008739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL EDE, MD INC

Provider Business Mailing Address
First Line	:	441 VINE ST
Second Line	:	CAREW TOWER 1005
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2821
Country	:	US
Telephone Number	:	513-621-5188
Fax Number	:	513-621-6354

Provider Business Practice Location Address
First Line	:	441 VINE ST
Second Line	:	CAREW TOWER 1005
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2821
Country	:	US
Telephone Number	:	513-621-5188
Fax Number	:	513-621-6354

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	DR. MITCHELL EDE
Credential	:	MD
Telephone Number	:	513-621-5188

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	05/26/2010

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