Provider Demographics
NPI:1174028443
Name:JUDE, AMANDA M (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:JUDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-5140
Mailing Address - Country:US
Mailing Address - Phone:513-674-1400
Mailing Address - Fax:
Practice Address - Street 1:3248 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5140
Practice Address - Country:US
Practice Address - Phone:513-674-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016017207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11774028443Medicaid