Provider Demographics
NPI:1275996670
Name:MUSE, KATHERINE AMELIA (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AMELIA
Last Name:MUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:AMELIA
Other - Last Name:HELMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:1425 N FAIRFIELD RD.
Practice Address - Street 2:120
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-4543
Practice Address - Country:US
Practice Address - Phone:937-320-8888
Practice Address - Fax:937-320-3848
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151564208000000X
OH35.137151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361840Medicaid