MEDICARE: DR. KEVIN BRENT KOURT 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	207R00000X	Internal Medicine Physician	21243	OK

General Provider Information

NPI Number	:	1538189212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN BRENT KOURT M.D.

Provider Business Mailing Address
First Line	:	5300 N. INDEPENDENCE
Second Line	:	SUITE 280
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	580-548-1544
Fax Number	:	580-548-1590

Provider Business Practice Location Address
First Line	:	620 S MADISON ST STE 209
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-7270
Country	:	US
Telephone Number	:	580-548-1544
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/06/2017

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