Provider Demographics
NPI:1790246981
Name:PENNEKAMP, ALEXANDER MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:MARK
Last Name:PENNEKAMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE CHRIST HOSPITAL
Mailing Address - Street 2:2139 AUBURN AVE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-585-2000
Mailing Address - Fax:
Practice Address - Street 1:THE CHRIST HOSPITAL
Practice Address - Street 2:2139 AUBURN AVE
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-585-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.030847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine