Provider Demographics
NPI:1790762136
Name:MUCK, PATRICK E (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:E
Last Name:MUCK
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 1:10506 MONTGOMERY RD STE 302
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10506 MONTGOMERY RD STE 302
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-865-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073515208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200416560Medicaid
OH3293506OtherAETNA
KY64093222Medicaid
OHP00038669OtherRAILROAD MEDICARE
OH2257687Medicaid
OH296983OtherAMERIGROUP
OH000000290056OtherANTHEM
OH2257687Medicaid
OHH30568Medicare UPIN
OHMU4102261Medicare PIN
OHMU4102265Medicare PIN
OHMU4102264Medicare PIN
OH4102267Medicare PIN
IN218520AMedicare PIN
OH4205077Medicare PIN