Provider Demographics
NPI:1679618995
Name:MOREMAN, KEVIN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:MOREMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N DIXIE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2520
Mailing Address - Country:US
Mailing Address - Phone:270-706-1918
Mailing Address - Fax:270-706-1910
Practice Address - Street 1:914 N DIXIE AVE STE 201
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2520
Practice Address - Country:US
Practice Address - Phone:270-706-1918
Practice Address - Fax:270-706-1910
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100040320Medicaid
KYP400043319Medicare PIN