Provider Demographics
NPI:1093787160
Name:BRUDZINSKI, ERIKA D (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:D
Last Name:BRUDZINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 NORTHLAKE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1658
Mailing Address - Country:US
Mailing Address - Phone:513-742-6310
Mailing Address - Fax:513-742-6318
Practice Address - Street 1:11500 NORTHLAKE DR STE 400
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1658
Practice Address - Country:US
Practice Address - Phone:513-742-6310
Practice Address - Fax:513-742-6318
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86180207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000488408OtherANTHEM BCBS
OH2601723Medicaid
OH4167032Medicare PIN
OHI38771Medicare UPIN