Provider Demographics
NPI:1235140864
Name:MARTIN, KEVIN J (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:MARTIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:SLUCARE ACADEMIC PAVILION #2419
Mailing Address - Street 2:1008 S. SPRING AVE
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-977-2650
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR SPECIALIZED MEDICINE / MULTI-DISCIPLINARY CL
Practice Address - Street 2:1225 SOUTH GRAND BLVD
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-977-2650
Practice Address - Fax:314-771-0784
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-01-13
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Provider Licenses
StateLicense IDTaxonomies
MO35906207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology