Provider Demographics
NPI:1528049053
Name:MOTE, EVELYN R (MD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:R
Last Name:MOTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 639295 DEPT 93394
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:937-293-2133
Mailing Address - Fax:855-252-2435
Practice Address - Street 1:3033 KETTERING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1948
Practice Address - Country:US
Practice Address - Phone:937-293-2133
Practice Address - Fax:855-252-2435
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35062357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2601947Medicaid
OH4229342Medicare PIN
OH4229341Medicare PIN