Provider Demographics
NPI:1992834915
Name:MICHAEL PORDY M.D. INC.
Entity Type:Organization
Organization Name:MICHAEL PORDY M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PORDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-281-7600
Mailing Address - Street 1:4760 E GALBRAITH RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6703
Mailing Address - Country:US
Mailing Address - Phone:513-281-7600
Mailing Address - Fax:
Practice Address - Street 1:4760 E GALBRAITH RD
Practice Address - Street 2:SUITE 114
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6703
Practice Address - Country:US
Practice Address - Phone:513-281-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH43735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457312Medicaid
OH0457312Medicaid
OH9236271Medicare ID - Type Unspecified