Provider Demographics
NPI:1548388341
Name:KEHRES, MARK G (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:KEHRES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:972-364-8000
Mailing Address - Fax:
Practice Address - Street 1:4623 WESLEY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2246
Practice Address - Country:US
Practice Address - Phone:513-608-7054
Practice Address - Fax:513-297-9017
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-10-01
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Provider Licenses
StateLicense IDTaxonomies
OH0595182083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9384551Medicare PIN
OH0713313Medicare UPIN