Healthcare Provider Details

I. General information

NPI: 1437190923
Provider Name (Legal Business Name): THOMAS JAMES KEREIAKES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT, PHYS DIV 2ND FL, CBO2-3, ATTN: CREDENTIALING
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-5558
  • Fax: 513-632-5804
Mailing address:
  • Phone: 513-263-8571
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number052064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: