Provider Demographics
NPI:1760759799
Name:PEMBAUR, KARL BERTHOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:BERTHOLD
Last Name:PEMBAUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3219 CLIFTON AVE
Mailing Address - Street 2:STE 325
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-3027
Mailing Address - Country:US
Mailing Address - Phone:513-861-0800
Mailing Address - Fax:513-861-5111
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:STE 404
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-241-5630
Practice Address - Fax:513-241-4661
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35122124207RN0300X
OH35.122124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100318530Medicaid
OH0092048Medicaid
OHH251162Medicare PIN
KYK123270Medicare PIN