MEDICARE: KEVAN IFFRIG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	30845	NE
2	208800000X	Urology Physician	MD469271	PA

General Provider Information

NPI Number	:	1215347471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVAN IFFRIG

Provider Business Mailing Address
First Line	:	EVANS ARMY COMMUNITY HOSPITAL
Second Line	:	1650 COCHRANE CIR B7500
City	:	FT CARSON
State	:	CO
Zip	:	80913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2649 SCHOENERSVILLE RD STE 101
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-7317
Country	:	US
Telephone Number	:	484-884-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	11/20/2023

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Directions to “ KEVAN IFFRIG ” Practice Location

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