Healthcare Provider Details

I. General information

NPI: 1326263781
Provider Name (Legal Business Name): KEVIN A HEATH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MAINE ST
LAWRENCE KS
66044-1360
US

IV. Provider business mailing address

325 MAINE ST
LAWRENCE KS
66044-1360
US

V. Phone/Fax

Practice location:
  • Phone: 785-505-6149
  • Fax: 785-505-2874
Mailing address:
  • Phone: 785-505-6149
  • Fax: 785-505-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number436665
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberN8925
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: