Provider Demographics
NPI:1225229917
Name:COUGHLIN, KEVIN J (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:COUGHLIN
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 1:2120 S 56TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2118
Mailing Address - Country:US
Mailing Address - Phone:402-488-6100
Mailing Address - Fax:402-488-6210
Practice Address - Street 1:2120 S 56TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2118
Practice Address - Country:US
Practice Address - Phone:402-488-6100
Practice Address - Fax:402-488-6210
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16127207Q00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2863OtherMIDLANDS CHOICE
NE10024996800Medicaid
NE07460OtherBCBS
NE07460OtherBCBS
NE2863OtherMIDLANDS CHOICE