Provider Demographics
NPI:1558939686
Name:MASARIK, CAYLA CLAIRE (MD)
Entity type:Individual
Prefix:
First Name:CAYLA
Middle Name:CLAIRE
Last Name:MASARIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-7210
Mailing Address - Fax:859-301-7216
Practice Address - Street 1:1808 BRISTOW DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-3513
Practice Address - Country:US
Practice Address - Phone:859-301-7210
Practice Address - Fax:859-301-7216
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY58716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program