Healthcare Provider Details

I. General information

NPI: 1770843716
Provider Name (Legal Business Name): KAHLEB GRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE., ML 2010
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE., ML 2010
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4415
  • Fax: 513-636-7805
Mailing address:
  • Phone: 513-636-4415
  • Fax: 513-636-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP02451
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLP02451
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberLP02451
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMT211479
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: