Provider Demographics
NPI:1124724828
Name:DIVINE MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:DIVINE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN E
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:KAMERER HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-824-9509
Mailing Address - Street 1:136 ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2941
Mailing Address - Country:US
Mailing Address - Phone:513-824-9509
Mailing Address - Fax:772-365-2818
Practice Address - Street 1:136 ANCHOR DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2941
Practice Address - Country:US
Practice Address - Phone:513-824-9509
Practice Address - Fax:772-365-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1821080946Medicaid
OH1487896791Medicaid