Provider Demographics
NPI:1750343224
Name:WHALEN, JOHN KEVIN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KEVIN
Last Name:WHALEN
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 1:7642 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-3204
Mailing Address - Country:US
Mailing Address - Phone:513-619-7766
Mailing Address - Fax:
Practice Address - Street 1:7642 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3204
Practice Address - Country:US
Practice Address - Phone:513-619-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.073148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64010788Medicaid
G75589Medicare UPIN
KY00271001Medicare PIN
KY0364907Medicare ID - Type Unspecified
OH2119273Medicaid