Provider Demographics
NPI:1326185406
Name:HISE, AMY GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:GRACE
Last Name:HISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2103 CORNELL RD
Mailing Address - Street 2:WRB 4-121
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-7286
Mailing Address - Country:US
Mailing Address - Phone:216-368-5016
Mailing Address - Fax:216-368-4825
Practice Address - Street 1:2103 CORNELL RD
Practice Address - Street 2:WRB 4-121
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-7286
Practice Address - Country:US
Practice Address - Phone:216-368-5016
Practice Address - Fax:216-368-4825
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35073503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine