MEDICARE: MARK G. KEHRES 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	2083X0100X	Occupational Medicine Physician	059518	OH

General Provider Information

NPI Number	:	1548388341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK G. KEHRES M.D.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	972-364-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4623 WESLEY AVE
Second Line	:	SUITE C
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2246
Country	:	US
Telephone Number	:	513-608-7054
Fax Number	:	513-297-9017

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	10/01/2013

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