Provider Demographics
NPI:1992708069
Name:GRODECKI, PATRICIA V (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:V
Last Name:GRODECKI
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 1:6905 BURLINGTON PIKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1618
Mailing Address - Country:US
Mailing Address - Phone:859-282-0500
Mailing Address - Fax:859-282-7324
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:BALDWIN BLDG. 5 SOUTH
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-1954
Practice Address - Fax:513-585-0607
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39058207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0892995Medicaid
KY50024714Medicaid
KY64093057Medicaid
KY0551829Medicare PIN
F41007Medicare UPIN
KY00954015Medicare PIN
KYP400036616Medicare PIN
OH0726754Medicare PIN
KYP00176102Medicare PIN