Provider Demographics
NPI:1033174842
Name:PEREZ, MAUREEN KENNEDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:KENNEDY
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 MERCHANT STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-6507
Mailing Address - Fax:513-645-9767
Practice Address - Street 1:1425 N FAIRFIELD RD.
Practice Address - Street 2:STE 110
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-4543
Practice Address - Country:US
Practice Address - Phone:937-426-0106
Practice Address - Fax:937-426-7153
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057332P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0723435Medicaid
OH0673682Medicare PIN
OH0673685Medicare PIN
080024405Medicare PIN
OH0673684Medicare PIN
OHE76068Medicare UPIN
OH0723435Medicaid
OHPE0673682Medicare PIN
OH0673687Medicare PIN