Healthcare Provider Details

I. General information

NPI: 1679686216
Provider Name (Legal Business Name): KEVIN JON KEMELHAR MED EDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23250 CHAPRIN BLVD #425 DR ELLEN F CASPER PHD & ASSOCIATES
BEACHWOOD OH
44122
US

IV. Provider business mailing address

23612 E SILSBY RD
BEACHWOOD OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-4243
  • Fax: 216-595-8210
Mailing address:
  • Phone: 216-381-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: