Provider Demographics
NPI:1528050481
Name:REDMOND, KEVIN P (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:REDMOND
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 1:234 GOODMAN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-584-3494
Mailing Address - Fax:513-584-4007
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-3494
Practice Address - Fax:513-584-4007
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-92012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH920000712OtherRAILROAD MEDICARE
TXP8B037461Medicaid
IN200039310AMedicaid
OH16-21000OtherUNITED HEALTHCARE
KY64787138Medicaid
WV3003880000Medicaid
OH0655266OtherAETNA
OH0627638Medicaid
OH295801OtherBLACK LUNG
TXP8B037461Medicaid
OH0655266OtherAETNA