Provider Demographics
NPI:1043337280
Name:MARTIN, KURTIS W (MD)
Entity type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:W
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KURTIS
Other - Middle Name:W
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6355 E KEMPER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2380
Mailing Address - Country:US
Mailing Address - Phone:513-469-0300
Mailing Address - Fax:513-469-0401
Practice Address - Street 1:6355 E KEMPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2380
Practice Address - Country:US
Practice Address - Phone:513-469-0300
Practice Address - Fax:513-469-0401
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH63752261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical