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NPI Code Detail

MEDICARE: KENNETH HOLBERT

MEDICARE: KENNETH HOLBERT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorOH

General Provider Information

NPI Number : 1013430156
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH HOLBERT
Provider Business Mailing Address
First Line : 12339 WAKE UNION CHURCH RD STE 108
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-4512
Country : US
Telephone Number : 919-263-9293
Fax Number :
Provider Business Practice Location Address
First Line : 5198 RICHMOND RD STE SOUTH
Second Line :
City : BEDFORD HEIGHTS
State : OH
Zip : 44146-1331
Country : US
Telephone Number : 216-378-9101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2017
Last Update Date : 07/20/2017

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Directions to “ KENNETH HOLBERT ” Practice Location

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