Provider Demographics
NPI:1083617997
Name:WINDISCH, KEVIN MERLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MERLE
Last Name:WINDISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:975 ROBERTA LN
Mailing Address - Street 2:STE 101B
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1897
Mailing Address - Country:US
Mailing Address - Phone:775-359-7111
Mailing Address - Fax:775-359-7114
Practice Address - Street 1:975 ROBERTA LN
Practice Address - Street 2:STE 101B
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1897
Practice Address - Country:US
Practice Address - Phone:775-359-7111
Practice Address - Fax:775-359-7114
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA063921208000000X
NV9023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016843Medicaid
NV3116843Medicaid