Provider Demographics
NPI:1073507547
Name:GALLOWAY, KEVIN L V (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:GALLOWAY
Suffix:V
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6004
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-6004
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3463
Practice Address - Country:US
Practice Address - Phone:601-376-2999
Practice Address - Fax:601-376-2989
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16585207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123174Medicaid
MSH30727Medicare UPIN
MS00123174Medicaid
IL208905120Medicare PIN
ILIL3270550Medicare PIN