Healthcare Provider Details

I. General information

NPI: 1093775041
Provider Name (Legal Business Name): MICHAEL J KIBELBEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML-5021
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE ML-5021
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4408
  • Fax: 513-636-7337
Mailing address:
  • Phone: 513-636-5013
  • Fax: 866-213-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35075428
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: