1073774147 NPI number — DR. JOHN P KACHORIS M.D.

Table of content: DR. JOHN P KACHORIS M.D. (NPI 1073774147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073774147 NPI number — DR. JOHN P KACHORIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KACHORIS
Provider First Name:
JOHN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073774147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4805 MONTGOMERY RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45212-2198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-961-5558
Provider Business Mailing Address Fax Number:
513-961-1912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4805 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45212-2198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-241-2370
Provider Business Practice Location Address Fax Number:
513-241-6053
Provider Enumeration Date:
06/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  35-093373 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084A2900X , with the licence number: 35.093373 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200949140 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100092860 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01132574 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2976669 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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