Provider Demographics
NPI:1255367512
Name:KAMBELOS, PETER J (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:KAMBELOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4767 N BEND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1825
Mailing Address - Country:US
Mailing Address - Phone:513-385-2566
Mailing Address - Fax:513-574-6800
Practice Address - Street 1:4767 N BEND RD
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1825
Practice Address - Country:US
Practice Address - Phone:513-385-2566
Practice Address - Fax:513-574-6800
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH68662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2195011Medicaid
OH9303371Medicare PIN
OH2195011Medicaid
OH0874602Medicare PIN