Healthcare Provider Details

I. General information

NPI: 1679555478
Provider Name (Legal Business Name): DENNIS M KOLB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242-4402
US

IV. Provider business mailing address

PO BOX 636799
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-745-2246
  • Fax: 513-745-5596
Mailing address:
  • Phone: 513-745-2246
  • Fax: 513-745-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35065383
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: