Healthcare Provider Details

I. General information

NPI: 1487858494
Provider Name (Legal Business Name): ROBERTA M KERN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 5 MILE RD STE 100
CINCINNATI OH
45230-2187
US

IV. Provider business mailing address

8000 5 MILE RD STE 100
CINCINNATI OH
45230-2187
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-6980
  • Fax: 513-233-6983
Mailing address:
  • Phone: 513-233-6980
  • Fax: 513-233-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.092247
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.092247
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: