Healthcare Provider Details

I. General information

NPI: 1770146201
Provider Name (Legal Business Name): KEVIN DOWNARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 N STATE ST
GREENFIELD IN
46140-1207
US

IV. Provider business mailing address

1841 COBBLESTONE WAY S
TERRE HAUTE IN
47802-5408
US

V. Phone/Fax

Practice location:
  • Phone: 844-695-7242
  • Fax:
Mailing address:
  • Phone: 765-541-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01091380A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01091380A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: