Healthcare Provider Details

I. General information

NPI: 1063509966
Provider Name (Legal Business Name): KENWOOD PEDIATRIC ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7835 REMINGTON RD
CINCINNATI OH
45242
US

IV. Provider business mailing address

7835 REMINGTON RD
CINCINNATI OH
45242
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1400
  • Fax: 513-984-3485
Mailing address:
  • Phone: 513-984-1400
  • Fax: 513-984-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT D LACKER
Title or Position: PRESIDENT
Credential: MD
Phone: 513-984-1400