Healthcare Provider Details

I. General information

NPI: 1205818986
Provider Name (Legal Business Name): KEVIN MICHAEL HEPLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 MEDICAL CENTER DR
BROAD TOP PA
16621-9001
US

IV. Provider business mailing address

4133 MEDICAL CENTER DR
BROAD TOP PA
16621-9001
US

V. Phone/Fax

Practice location:
  • Phone: 814-635-2916
  • Fax:
Mailing address:
  • Phone: 814-635-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD029204E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: