Healthcare Provider Details

I. General information

NPI: 1124065438
Provider Name (Legal Business Name): DEBRA L BRENEMAN M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HIGHLAND AVE
CINCINNATI OH
45219-2399
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-3686
  • Fax: 513-475-7636
Mailing address:
  • Phone: 513-585-5502
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.052109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: