Provider Demographics
NPI:1831183557
Name:PALMER, KENNETH EUGENE (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:PALMER
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 1:2123 AUBURN AVE
Mailing Address - Street 2:SUITE 724
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-241-4774
Mailing Address - Fax:513-241-1682
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 724
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-241-4774
Practice Address - Fax:513-241-1682
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033607P207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0178338Medicaid
A73831Medicare UPIN
PA0370591Medicare ID - Type Unspecified