Healthcare Provider Details

I. General information

NPI: 1992810717
Provider Name (Legal Business Name): KEVIN C MCDONALD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 LEE ANN DR NE
CONCORD NC
28025-2911
US

IV. Provider business mailing address

1022 LEE-ANN DRIVE NE
CONCORD NC
28025
US

V. Phone/Fax

Practice location:
  • Phone: 704-786-4482
  • Fax: 704-786-0604
Mailing address:
  • Phone: 704-886-1918
  • Fax: 704-257-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number443
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number443
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number443
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: