Provider Demographics
NPI:1477915254
Name:STROMBERG, KEVIN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DANIEL
Last Name:STROMBERG
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 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3031
Mailing Address - Fax:513-558-5511
Practice Address - Street 1:231 ALBERT SABIN WAY FL 5
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-3908
Practice Address - Country:US
Practice Address - Phone:513-558-5151
Practice Address - Fax:513-558-3108
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35139925207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program