Provider Demographics
NPI:1467467852
Name:PEAKE, PAULA L (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:L
Last Name:PEAKE
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 1:8000 FIVE MILE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2189
Mailing Address - Country:US
Mailing Address - Phone:513-233-2444
Mailing Address - Fax:513-233-0621
Practice Address - Street 1:8000 FIVE MILE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2189
Practice Address - Country:US
Practice Address - Phone:513-233-2444
Practice Address - Fax:513-233-0621
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2538810Medicaid
OH2538810Medicaid
OHI12477Medicare UPIN