Provider Demographics
NPI:1427025055
Name:KEREIAKES, DEAN (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:KEREIAKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-206-1060
Mailing Address - Fax:513-206-1062
Practice Address - Street 1:2123 AUBURN AVE STE 136
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-206-1060
Practice Address - Fax:513-206-1062
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050880207RC0000X
OH35.05088207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000019743OtherANTHEM
0641590OtherAETNA
2520396OtherUNITED
2833852OtherAMERIGROUP
OH0587057Medicaid
5088005OtherHUMANA
TXP8B127810Medicaid
311438871032OtherCARESOURCE
IN100009830Medicaid
KY64787609Medicaid
OH0564684Medicare PIN
0641590OtherAETNA
OH0564867Medicare PIN