MEDICARE: ROBERTA M KERN MD

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	207QS0010X	Sports Medicine (Family Medicine) Physician	35.092247	OH
2	207Q00000X	Family Medicine Physician	35.092247	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57012142	OTHER	OH	MD TRAINING CERTIFICATE

General Provider Information

NPI Number	:	1487858494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA M KERN MD

Provider Business Mailing Address
First Line	:	8000 5 MILE RD STE 100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2187
Country	:	US
Telephone Number	:	513-233-6980
Fax Number	:	513-233-6983

Provider Business Practice Location Address
First Line	:	8000 5 MILE RD STE 100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2187
Country	:	US
Telephone Number	:	513-233-6980
Fax Number	:	513-233-6983

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	01/24/2024

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Directions to “ ROBERTA M KERN MD” Practice Location

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