MEDICARE: DR. ALEXANDER MARK PENNEKAMP DO

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	34.015436	OH
2	207RN0300X	Nephrology Physician	34.015436	OH

General Provider Information

NPI Number	:	1790246981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER MARK PENNEKAMP DO

Provider Business Mailing Address
First Line	:	2123 AUBURN AVE STE 404
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2906
Country	:	US
Telephone Number	:	513-241-5630
Fax Number	:	513-241-7146

Provider Business Practice Location Address
First Line	:	2123 AUBURN AVE STE 404
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2906
Country	:	US
Telephone Number	:	513-241-5630
Fax Number	:	513-241-7146

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

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	05/27/2026

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