Caroline H Kennebeck MD Inc

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

35086104 Issued in OH

Legal business name

CAROLINE H KENNEBECK MD INC

Practice address

5701 Far Hills Ave
Dayton, OH 45429-2207

Phone

(937) 435-6222

NPI assigned

Jul 24, 2007

Last updated

Jul 24, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lois Ann Sewak

Title

Sec. of Corp.

Phone

(937) 435-6222

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185235200000",
    "number": "1588864870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 FAR HILLS AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454292207",
            "telephone_number": "937-435-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 FAR HILLS AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454292207",
            "telephone_number": "937-435-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINE H KENNEBECK MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2007-07-24",
        "status": "A",
        "authorized_official_last_name": "SEWAK",
        "authorized_official_first_name": "LOIS",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "SEC. OF CORP.",
        "authorized_official_telephone_number": "937-435-6222",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "35086104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "CA9356401",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER ID",
            "identifier": "KE4167291",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2605738",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Obstetrics & Gynecology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.