Healthcare Provider Details

I. General information

NPI: 1306056015
Provider Name (Legal Business Name): KRISTIN L KALTENSTADLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 CHILDRENS DRIVE, BUILDING D
MASON OH
45040-6791
US

IV. Provider business mailing address

9600 CHILDRENS DRIVE, BUILDING D
MASON OH
45040-6791
US

V. Phone/Fax

Practice location:
  • Phone: 513-336-6700
  • Fax: 513-398-2109
Mailing address:
  • Phone: 513-336-6700
  • Fax: 513-398-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.094211
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35.094211
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: