Individual
KENNETH T HEBERLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL VILLAGE DR, ST. ELIZABETH HEALTHCARE, EDGEWOOD, KY 41017-3403
(859) 344-7207
(859) 344-5553
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 344-5555
(859) 344-5552
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
39322
KY
207R00000X
Internal Medicine Physician
35083786
OH
207R00000X
Internal Medicine Physician
Primary
39322
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200977020
—
IN
05
—
2594652
—
OH
05
—
64107600
—
KY
Enumeration date
08/26/2005
Last updated
05/03/2012
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