Basic Information
| Provider Information | |||||||||
| NPI: | 1992708069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRODECKI | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6905 BURLINGTON PIKE | ||||||||
| Address2: | SUITE E | ||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410421618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592820500 | ||||||||
| FaxNumber: | 8592827324 | ||||||||
| Practice Location | |||||||||
| Address1: | 2139 AUBURN AVE | ||||||||
| Address2: | BALDWIN BLDG. 5 SOUTH | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135851954 | ||||||||
| FaxNumber: | 5135850607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 03/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 39058 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0892995 | 05 | OH | MEDICAID | 50024714 | 05 | KY | MEDICAID | 64093057 | 05 | KY | MEDICAID |