Provider Demographics
NPI:1649217688
Name:KLEIMEYER, TED A (MD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:A
Last Name:KLEIMEYER
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:PO BOX 636298
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6298
Mailing Address - Country:US
Mailing Address - Phone:513-347-7237
Mailing Address - Fax:513-347-6567
Practice Address - Street 1:4983 DELHI AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5380
Practice Address - Country:US
Practice Address - Phone:513-347-7237
Practice Address - Fax:513-347-6567
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350453832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200067080Medicaid
KY64865074Medicaid
OH0485765Medicaid
KY64865074Medicaid
IN200067080Medicaid
OHP00352395Medicare PIN