MEDICARE: DR. KEVIN D MARTIN 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	174400000X	Specialist	26395	KY
2	208600000X	Surgery Physician	26395	KY
3	2086S0129X	Vascular Surgery Physician	01072246A	IN
4	2086S0129X	Vascular Surgery Physician	26395	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00252697	OTHER	KY	RAILROAD MEDICARE
4	770000278	OTHER	OH	RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801888219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN D MARTIN MD

Provider Business Mailing Address
First Line	:	PO BOX 635283
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5283
Country	:	US
Telephone Number	:	859-344-1600
Fax Number	:	859-344-0091

Provider Business Practice Location Address
First Line	:	20 MEDICAL VILLAGE DR STE 254
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-5401
Country	:	US
Telephone Number	:	859-344-1600
Fax Number	:	859-344-0091

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/04/2021

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Directions to “ DR. KEVIN D MARTIN MD” Practice Location

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