Healthcare Provider Details

I. General information

NPI: 1154391324
Provider Name (Legal Business Name): KELLEY A KIRWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7655 5 MILE RD SUITE 101
CINCINNATI OH
45230-4326
US

IV. Provider business mailing address

7655 5 MILE RD SUITE 101
CINCINNATI OH
45230-4326
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-3345
  • Fax: 513-624-2588
Mailing address:
  • Phone: 513-231-3345
  • Fax: 513-624-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35058018
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: