MEDICARE: DR. KEVIN MALOY BINGLE MD

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	4301113469	MI
2	207Q00000X	Family Medicine Physician	35.140377	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301113469	OTHER	MI	NA

General Provider Information

NPI Number	:	1538681812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MALOY BINGLE MD

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST FL 7
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1531
Country	:	US
Telephone Number	:	419-891-6210
Fax Number	:	419-893-3232

Provider Business Practice Location Address
First Line	:	660 BEAVER CREEK CIR STE 110
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-1746
Country	:	US
Telephone Number	:	419-891-6210
Fax Number	:	419-893-3232

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

Provider Enumeration Date	:	07/08/2017
Last Update Date	:	11/03/2023

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