Provider Demographics
NPI:1194785113
Name:KORTEKAMP, GERARD E (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:E
Last Name:KORTEKAMP
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 1:4380 MALSBARY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5644
Mailing Address - Country:US
Mailing Address - Phone:513-366-4488
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 520
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-1300
Practice Address - Fax:513-585-1358
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049141K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000569046OtherANTHEM PIN
OH0592514Medicaid
IN200468150Medicaid
KY64787575Medicaid
A82203Medicare UPIN
KY64787575Medicaid
OHKO0570826Medicare PIN