MEDICARE: DR. TIMOTHY EDWARD KREMCHEK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	35-05-6040	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000021083	OTHER	OH	ANTHEM
2	0901041	OTHER	OH	UNITED HEALTH CARE
3	955119	OTHER	OH	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	410333	OTHER	OH	WELLCARE
6	56040	OTHER	OH	HUMANA

General Provider Information

NPI Number	:	1467442335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY EDWARD KREMCHEK M.D.

Provider Business Mailing Address
First Line	:	500 E-BUSINESS WAY
Second Line	:	SUITE A
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1319
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-354-3705

Provider Business Practice Location Address
First Line	:	6480 HARRISON AVE
Second Line	:	SUITE 201
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7961
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-354-7651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	10/02/2012

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Directions to “ DR. TIMOTHY EDWARD KREMCHEK M.D.” Practice Location

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