Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 35-08-1039 | OH |
NPI | 1003809484 |
---|---|
Provider Name | Keith R Berend |
First Address | New Albany, OH 43054-8195 |
Second Address | New Albany, OH 43054-8195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 11/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2322034 | (05) | OH |
H57601 | (02) | OH |