Provider Demographics
NPI:1902883937
Name:TODD, MICHAEL ULLAND (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ULLAND
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MCAULEY PL STE 112
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4765
Mailing Address - Country:US
Mailing Address - Phone:513-981-4646
Mailing Address - Fax:513-981-4647
Practice Address - Street 1:4600 MCAULEY PL STE 112
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4765
Practice Address - Country:US
Practice Address - Phone:513-981-4646
Practice Address - Fax:513-981-4647
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070241T207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0266751Medicaid
OHP00754846OtherMEDICARE RR
OH0804092Medicare PIN
OHP00754846OtherMEDICARE RR