Provider Demographics
NPI:1912907239
Name:KIRKHAM, LEA N (MD)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:N
Last Name:KIRKHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11238 CORNELL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-1812
Mailing Address - Country:US
Mailing Address - Phone:513-530-0200
Mailing Address - Fax:513-530-0730
Practice Address - Street 1:11238 CORNELL PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-1812
Practice Address - Country:US
Practice Address - Phone:513-530-0200
Practice Address - Fax:513-530-0730
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2030117Medicaid