Provider Demographics
NPI:1750381315
Name:HILGENBERG, KEVIN L (PA-C)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:HILGENBERG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 5 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4346
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-232-2522
Practice Address - Street 1:7575 5 MILE ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4346
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-232-2522
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 0025222255A2300X
OH50.003009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000649071OtherANTHEM
OH000000649071OtherANTHEM
OHHIPA34761Medicare PIN