MEDICARE: KEVIN MICHAEL DINEEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	20319	SC
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	20319	SC
3	207RP1001X	Pulmonary Disease Physician	20319	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639175516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MICHAEL DINEEN MD

Provider Business Mailing Address
First Line	:	PO BOX 3239
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-3239
Country	:	US
Telephone Number	:	843-366-3729
Fax Number	:	843-777-7102

Provider Business Practice Location Address
First Line	:	3980 HIGHWAY 9 E
Second Line	:	SUITE 340
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8163
Country	:	US
Telephone Number	:	843-390-8302
Fax Number	:	843-390-8315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	02/02/2021

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Directions to “ KEVIN MICHAEL DINEEN MD” Practice Location

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