Provider Demographics
NPI:1609008739
Name:MITCHELL EDE, MD INC
Entity Type:Organization
Organization Name:MITCHELL EDE, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-621-5188
Mailing Address - Street 1:441 VINE ST
Mailing Address - Street 2:CAREW TOWER 1005
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2821
Mailing Address - Country:US
Mailing Address - Phone:513-621-5188
Mailing Address - Fax:513-621-6354
Practice Address - Street 1:441 VINE ST
Practice Address - Street 2:CAREW TOWER 1005
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2821
Practice Address - Country:US
Practice Address - Phone:513-621-5188
Practice Address - Fax:513-621-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0613189Medicaid
OH0094841Medicare UPIN