Provider Demographics
NPI:1700938735
Name:PORDY, MICHAEL GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GREGORY
Last Name:PORDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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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:513-281-7993
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:513-281-7993
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH43735207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457312Medicaid
OHC02080Medicare UPIN
OH0457312Medicaid