Provider Demographics
NPI:1518992395
Name:FEDERER, MICHELLE LEE (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:FEDERER
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 1:8000 FIVE MILE ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2190
Mailing Address - Country:US
Mailing Address - Phone:513-559-7175
Mailing Address - Fax:513-559-7194
Practice Address - Street 1:8000 FIVE MILE ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2190
Practice Address - Country:US
Practice Address - Phone:513-559-7175
Practice Address - Fax:513-559-7194
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007416207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2499452Medicaid
I10829Medicare UPIN
OH2499452Medicaid