Healthcare Provider Details

I. General information

NPI: 1457344855
Provider Name (Legal Business Name): KURT A BERLEKAMP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7277 SMITHS MILL RD STE 200
NEW ALBANY OH
43054-8195
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 614-221-6331
  • Fax: 614-221-9042
Mailing address:
  • Phone: 513-713-1779
  • Fax: 513-854-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.001014RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001014
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: