MEDICARE: JESSICA ELYSE UHLER MD

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	390200000X	Student in an Organized Health Care Education/Training Program	11020726A	IN
2	207R00000X	Internal Medicine Physician	35.143979	OH

General Provider Information

NPI Number	:	1750842548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ELYSE UHLER MD

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD BLDG B
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3188
Fax Number	:	937-223-9811

Provider Business Practice Location Address
First Line	:	35 OVERBROOK DR STE 100
Second Line	:
City	:	MONROE
State	:	OH
Zip	:	45050-1199
Country	:	US
Telephone Number	:	513-539-7356
Fax Number	:	513-539-7782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	08/23/2022

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