Provider Demographics
NPI:1053314963
Name:RANKIN, KEVIN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARK
Last Name:RANKIN
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 1:222 22ND AVE N
Mailing Address - Street 2:STE 400
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1831
Mailing Address - Country:US
Mailing Address - Phone:615-329-5144
Mailing Address - Fax:615-284-2751
Practice Address - Street 1:222 22ND AVE N
Practice Address - Street 2:STE 400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1831
Practice Address - Country:US
Practice Address - Phone:615-329-5144
Practice Address - Fax:615-284-2751
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24232174400000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3867032Medicaid
TN3867031Medicaid
TN3867031Medicare ID - Type Unspecified
TN3867032Medicare PIN
TNG23655Medicare UPIN