Small, Kevin M

Small, Kevin M is an individual health care provider with primary practice located at 621 Memorial Dr Ste 312 , South Bend IN 46601-1073. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology, which is considered as his primary health care specialty. Small, Kevin M can be contacted via phone (574) 647-5200.

Contact Information

Primary practice address
621 Memorial Dr Ste 312 South Bend IN 46601-1073
Phone: (574) 647-5200
Fax: (574) 647-5210
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 01044597A Indiana

Profile Details

NPI number 1689669715
LBN Legal business name Small, Kevin M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2005
Last updated Apr 5th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689669715 NPPES
Indiana MEDICAID 200181930

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