Healthcare Provider Details

I. General information

NPI: 1184044232
Provider Name (Legal Business Name): KELLY RENEE LAIPPLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST ML0781
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-4505
  • Fax: 513-584-0468
Mailing address:
  • Phone: 513-245-3072
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35139243
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: