=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013446079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN ROWE PHYSICIAN ASSISTANT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2017
-----------------------------------------------------
Last Update Date | 06/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5101 12TH ARMOR DIVISION AVE 8-229TH ASSAULT HELICOPTER BATTALION HQ
-----------------------------------------------------
City | FORT KNOX
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40121-2173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-479-4637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 464 N ABERDEEN ST APT 3F
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60642-6548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-479-4637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------