Provider Demographics
NPI:1134393408
Name:BRIDGES, KATHLEEN F (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:F
Other - Last Name:GREVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 5 MILE RD
Mailing Address - Street 2:STE. 305
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2163
Mailing Address - Country:US
Mailing Address - Phone:513-232-3500
Mailing Address - Fax:513-624-2704
Practice Address - Street 1:8000 5 MILE RD
Practice Address - Street 2:STE. 305
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2163
Practice Address - Country:US
Practice Address - Phone:513-232-3500
Practice Address - Fax:513-624-2704
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2034908Medicaid
OH2034908Medicaid