MEDICARE: KEVIN R ACKLEY MD

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	207P00000X	Emergency Medicine Physician	18592	WV
2	207P00000X	Emergency Medicine Physician	35067544-A	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952340903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN R ACKLEY MD

Provider Business Mailing Address
First Line	:	4415 AICHOLTZ ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-5139
Country	:	US
Telephone Number	:	513-752-9610
Fax Number	:	513-732-8734

Provider Business Practice Location Address
First Line	:	4415 AICHOLTZ RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1506
Country	:	US
Telephone Number	:	513-752-9610
Fax Number	:	513-732-8734

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	06/15/2012

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Directions to “ KEVIN R ACKLEY MD” Practice Location

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