# MARY ELLEN BROADSTONE GAEKE, MD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952362485
- **Authorized official:** MARY ELLEN GAEKE MD (OWNER)
- **Authorized official phone:** (513) 422-3119

## Contact information

- **Practice address:** 82 N BREIEL BLVD, MIDDLETOWN, OH 45042-3804
- **Practice address phone:** (513) 422-3119
- **Practice address fax:** (513) 420-1848
- **Mailing address:** 82 N BREIEL BLVD, MIDDLETOWN, OH 45042-3804
- **Mailing address phone:** (513) 422-3119
- **Mailing address fax:** (513) 420-1848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | Yes |
| 207RH0003X | Hematology & Oncology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/02/2006
- **Last updated:** 08/22/2020