MEDICARE: KIM L ROEBUCK 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	2084P0800X	Psychiatry Physician	35-05-1318-R	OH

General Provider Information

NPI Number	:	1881781607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM L ROEBUCK M.D.

Provider Business Mailing Address
First Line	:	8160 RED MILL DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1748
Country	:	US
Telephone Number	:	513-777-7289
Fax Number	:	513-893-3264

Provider Business Practice Location Address
First Line	:	3101 DIXIE HWY
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45015-1653
Country	:	US
Telephone Number	:	513-737-3400
Fax Number	:	513-893-3264

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/21/2011

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