Provider Demographics
NPI:1033219365
Name:HORVATH, KEVIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:HORVATH
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 1:1483 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371
Mailing Address - Country:US
Mailing Address - Phone:937-667-7711
Mailing Address - Fax:937-667-8067
Practice Address - Street 1:1483 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371
Practice Address - Country:US
Practice Address - Phone:937-667-7711
Practice Address - Fax:937-667-8067
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051737H2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0588958Medicaid