MEDICARE: DR. KEVIN JOSEPH NOLAN M.D.

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	2001-272	NM

General Provider Information

NPI Number	:	1386629541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN JOSEPH NOLAN M.D.

Provider Business Mailing Address
First Line	:	210B ALBATROSS AVE
Second Line	:
City	:	KODIAK
State	:	AK
Zip	:	99615-6806
Country	:	US
Telephone Number	:	907-487-5757
Fax Number	:

Provider Business Practice Location Address
First Line	:	210B ALBATROSS AVE
Second Line	:
City	:	KODIAK
State	:	AK
Zip	:	99615-6806
Country	:	US
Telephone Number	:	907-487-5757
Fax Number	:

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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