Provider Demographics
NPI:1275538373
Name:DREW, KEVIN GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GENE
Last Name:DREW
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 1:3740 EDISON LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3448
Mailing Address - Country:US
Mailing Address - Phone:574-252-4150
Mailing Address - Fax:574-252-4159
Practice Address - Street 1:3740 EDISON LAKES PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3448
Practice Address - Country:US
Practice Address - Phone:574-252-4150
Practice Address - Fax:574-252-4159
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010428632081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103506865Medicaid
IN200137230AMedicaid
MI35205027103Medicaid
IN000000093083OtherANTHEM BLUE CROSS BLUE SH
MI103400810Medicaid
MI104240346Medicaid
IN250009418OtherRR MEDICARE
MI250A110370OtherBLUE CROSS/SHIELD MICHIGA
IN3520574OtherTRICARE HEALTHNET
IN129646400OtherUS DEPT OF LABOR
MIM81880001Medicare ID - Type Unspecified
IN129646400OtherUS DEPT OF LABOR
F87496Medicare UPIN
IN134820AMedicare ID - Type Unspecified