Provider Demographics
NPI:1134111099
Name:MCLEOD, KEVIN C I (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:MCLEOD
Suffix:I
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 1:2910 CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4227
Mailing Address - Country:US
Mailing Address - Phone:870-246-5097
Mailing Address - Fax:870-246-9693
Practice Address - Street 1:2910 CYPRESS RD
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4227
Practice Address - Country:US
Practice Address - Phone:870-246-5097
Practice Address - Fax:870-246-9693
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4012207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR276804OtherHEALTHLINK
AR116444001Medicaid
AR5932105OtherAETNA
ARP00412890Medicare PIN
AR0904380015Medicare NSC
AR276804OtherHEALTHLINK
AR53394Medicare PIN