Healthcare Provider Details

I. General information

NPI: 1124345996
Provider Name (Legal Business Name): JONATHAN MICHAEL KREMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

3200 BURNET AVE 3 SOUTH CREDENTIALING
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-6789
  • Fax: 513-584-4003
Mailing address:
  • Phone: 513-585-5503
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.123307
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57-018101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: