MEDICARE: DR. PETER J KAMBELOS M.D.

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
1	207R00000X	Internal Medicine Physician	68662	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255367512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER J KAMBELOS M.D.

Provider Business Mailing Address
First Line	:	4767 N BEND RD
Second Line	:	SUITE A
City	:	CINCINNATI
State	:	OH
Zip	:	45211-1825
Country	:	US
Telephone Number	:	513-385-2566
Fax Number	:	513-574-6800

Provider Business Practice Location Address
First Line	:	4767 N BEND RD
Second Line	:	SUITE A
City	:	CINCINNATI
State	:	OH
Zip	:	45211-1825
Country	:	US
Telephone Number	:	513-385-2566
Fax Number	:	513-574-6800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	01/11/2013

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