Provider Demographics
NPI:1114134301
Name:MIETHKE, ALEXANDER GERHARD (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GERHARD
Last Name:MIETHKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:ML 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-5013
Mailing Address - Fax:866-213-7084
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:GASTROENTEROLOGY & NUTRITION ML 2010
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4415
Practice Address - Fax:513-636-7805
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH570062042080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology