Individual
KATHRYN WIKENHEISER-BROKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 BURNET AVE # MLC1010, DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE, CINCINNATI, OH 45229-3026
(513) 803-0239
(513) 636-3924
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 585-5507
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
35-08-3105
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000302667
ANTHEM
OH
01
—
11-01348
UNITED HEALTHCARE
OH
05
—
200455000
—
IN
05
—
2424120
—
OH
05
—
64069826
—
KY
01
—
7890492
AETNA
OH
Enumeration date
07/21/2006
Last updated
12/13/2017
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