Provider Demographics
NPI:1679790190
Name:WU, JEFFREY K (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2309
Mailing Address - Country:US
Mailing Address - Phone:513-271-3222
Mailing Address - Fax:513-271-3134
Practice Address - Street 1:11140 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2309
Practice Address - Country:US
Practice Address - Phone:513-271-3222
Practice Address - Fax:513-271-3135
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-089555207X00000X
IN01069671A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2744696Medicaid
IN201029770Medicaid
KY7100355960Medicaid
OH2744696Medicaid
OHH380280Medicare PIN
INM400052890Medicare PIN