Provider Demographics
NPI:1760411441
Name:TEPE, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:TEPE
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 1:820 S MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-3216
Mailing Address - Country:US
Mailing Address - Phone:513-868-5142
Mailing Address - Fax:513-737-8196
Practice Address - Street 1:820 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3216
Practice Address - Country:US
Practice Address - Phone:513-868-5142
Practice Address - Fax:513-737-8196
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3504111162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0369079Medicaid
OH0369079Medicaid
A77552Medicare UPIN