MEDICARE: DR. KEVIN KUMAR MATHUR 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	207Y00000X	Otolaryngology Physician	35082464M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598869216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN KUMAR MATHUR M.D.

Provider Business Mailing Address
First Line	:	1749 CLEVELAND RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-2203
Country	:	US
Telephone Number	:	330-264-9699
Fax Number	:	330-264-7999

Provider Business Practice Location Address
First Line	:	1749 CLEVELAND RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-2203
Country	:	US
Telephone Number	:	330-264-9699
Fax Number	:	330-264-7999

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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