Provider Demographics
NPI:1467442335
Name:KREMCHEK, TIMOTHY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:KREMCHEK
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 1:500 E-BUSINESS WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1319
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-3705
Practice Address - Street 1:6480 HARRISON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7961
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-354-7651
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-6040207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000021083OtherANTHEM
OH0901041OtherUNITED HEALTH CARE
OH955119OtherAETNA
OH0941306Medicaid
OH410333OtherWELLCARE
OH56040OtherHUMANA
OH0901041OtherUNITED HEALTH CARE
OH0941306Medicaid