Basic Information
| Provider Information | |||||||||
| NPI: | 1013924851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALDEMEYER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 COMPTON ROAD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137612776 | ||||||||
| FaxNumber: | 5136794866 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 COMPTON ROAD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137612776 | ||||||||
| FaxNumber: | 5136794866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 09/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35051718 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100101620 | 05 | KY | MEDICAID | 0605401 | 05 | OH | MEDICAID |