Provider Demographics
NPI:1578632501
Name:PHYSICIAN ASSOCIATES OF KEMPER,INC
Entity Type:Organization
Organization Name:PHYSICIAN ASSOCIATES OF KEMPER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-671-2902
Mailing Address - Street 1:5770 KUGLER MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2040
Mailing Address - Country:US
Mailing Address - Phone:513-671-2902
Mailing Address - Fax:
Practice Address - Street 1:140 W KEMPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2530
Practice Address - Country:US
Practice Address - Phone:513-671-2902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071677D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3790099OtherAETNA
OH000000357567OtherANTHEM
OH2103048Medicaid
OH301922282004OtherMEDICAL MUTUAL OF OHIO
OH=========027OtherCARE SOURCE
OH000000357567OtherANTHEM
OH=========OtherHUMANA
OH=========OtherUNITED HEALTH CARE
OH3790099OtherAETNA
OH=========OtherHUMANA