Healthcare Provider Details

I. General information

NPI: 1215991443
Provider Name (Legal Business Name): KEVIN D SLENTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W WALNUT ST
LEBANON KY
40033-1346
US

IV. Provider business mailing address

429 W WALNUT ST
LEBANON KY
40033-1346
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-5617
  • Fax: 502-570-5610
Mailing address:
  • Phone: 502-868-5617
  • Fax: 502-570-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01045043A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME109212
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number47235
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: