Healthcare Provider Details

I. General information

NPI: 1851348908
Provider Name (Legal Business Name): GEORGE KERLAKIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 DIXMYTH AVE
CINCINNATI OH
45220
US

IV. Provider business mailing address

4685 FOREST AVE STE C
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7000
  • Fax: 513-246-7852
Mailing address:
  • Phone: 513-246-7800
  • Fax: 513-246-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35050499
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: