Provider Demographics
NPI:1457398398
Name:LENZ, KELLENE M (MD)
Entity type:Individual
Prefix:
First Name:KELLENE
Middle Name:M
Last Name:LENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLENE
Other - Middle Name:M
Other - Last Name:MCMANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 MERCY HEALTH BOULEVARD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1112
Mailing Address - Country:US
Mailing Address - Phone:513-981-5922
Mailing Address - Fax:513-385-6430
Practice Address - Street 1:3301 MERCY HEALTH BOULEVARD
Practice Address - Street 2:SUITE 340
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1112
Practice Address - Country:US
Practice Address - Phone:513-981-5922
Practice Address - Fax:513-385-6430
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00919628OtherMEDICARE RR
OH2036648Medicaid
OHG45185Medicare UPIN
OH2036648Medicaid