Provider Demographics
NPI:1164230124
Name:TEKULVE, BRENDAN (CPRS, CDCA)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:TEKULVE
Suffix:
Gender:M
Credentials:CPRS, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 BURDETTE CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2113
Mailing Address - Country:US
Mailing Address - Phone:513-704-9587
Mailing Address - Fax:
Practice Address - Street 1:3304 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1316
Practice Address - Country:US
Practice Address - Phone:513-704-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004334175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist