MEDICARE: DR. KEVIN C. CONSIDINE D.O.

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	207Q00000X	Family Medicine Physician	20A6446	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A6446	OTHER	CA	MEDICARE

General Provider Information

NPI Number	:	1215918271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN C. CONSIDINE D.O.

Provider Business Mailing Address
First Line	:	230 PROSPECT PL
Second Line	:	SUITE 350
City	:	CORONADO
State	:	CA
Zip	:	92118-1978
Country	:	US
Telephone Number	:	619-537-6910
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 PROSPECT PL
Second Line	:	SUITE 350
City	:	CORONADO
State	:	CA
Zip	:	92118-1978
Country	:	US
Telephone Number	:	619-537-6910
Fax Number	:

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	10/06/2022

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