Provider Demographics
NPI:1134158710
Name:SOMSAK, DENISE A (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:SOMSAK
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 1:4370 MALSBARY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5653
Mailing Address - Country:US
Mailing Address - Phone:513-791-1222
Mailing Address - Fax:513-791-2561
Practice Address - Street 1:4370 MALSBARY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5653
Practice Address - Country:US
Practice Address - Phone:513-791-1222
Practice Address - Fax:513-791-2561
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.075533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics