Healthcare Provider Details

I. General information

NPI: 1144226085
Provider Name (Legal Business Name): KEVIN B CLAFFEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date: 06/24/2005
Reactivation Date: 07/01/2005

III. Provider practice location address

4218 LINCOLNSHIRE DR
MOUNT VERNON IL
62864-2156
US

IV. Provider business mailing address

4218 LINCOLNSHIRE DR PO BOX 968
MOUNT VERNON IL
62864-2156
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-8480
  • Fax: 618-242-8499
Mailing address:
  • Phone: 618-242-8480
  • Fax: 618-242-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: