Provider Demographics
NPI:1285818583
Name:LOKKESMOE, KEVIN DONALD (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DONALD
Last Name:LOKKESMOE
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:PO BOX 8387
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8387
Mailing Address - Country:US
Mailing Address - Phone:706-507-1213
Mailing Address - Fax:706-507-1217
Practice Address - Street 1:4328 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5204
Practice Address - Country:US
Practice Address - Phone:706-507-1213
Practice Address - Fax:706-507-1217
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine