Provider Demographics
NPI:1730114588
Name:MAEDER, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:MAEDER
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 1:2727 MADISON RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2276
Mailing Address - Country:US
Mailing Address - Phone:513-321-0833
Mailing Address - Fax:513-321-6063
Practice Address - Street 1:2727 MADISON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2276
Practice Address - Country:US
Practice Address - Phone:513-321-0833
Practice Address - Fax:513-321-6063
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.033694207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0365948Medicaid
OH0365948Medicaid
OH110124253Medicare PIN