Individual
DR. KERITH ELIZABETH SPICKNALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
222 PIEDMONT AVE, CINCINNATI, OH 45219-4231
(513) 474-7630
(513) 475-7636
Mailing address
PO BOX 636256, CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 585-5505
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35093057
OH
207N00000X
Dermatology Physician
4301088164
MI
207ND0900X
Dermatopathology Physician
4301088164
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200962450
—
IN
05
—
2984043
—
OH
05
—
7100094580
—
KY
Enumeration date
05/16/2007
Last updated
06/08/2017
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