Provider Demographics
NPI:1063509966
Name:KENWOOD PEDIATRIC ASSOC INC
Entity Type:Organization
Organization Name:KENWOOD PEDIATRIC ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:LACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-984-1400
Mailing Address - Street 1:7835 REMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-984-1400
Mailing Address - Fax:513-984-3485
Practice Address - Street 1:7835 REMINGTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-984-1400
Practice Address - Fax:513-984-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty