Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | OT011562 | PA |
Y | 207RA0401X | Internist - Addiction Medicine | 34.014443 | OH |
NPI | 1053560433 |
---|---|
Provider Name | Deana Kimes |
First Address | Cincinnati, OH 45202-1459 |
Second Address | Warren, OH 44483-6618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 22/02/2021 |