Provider Demographics
NPI:1447245725
Name:RIGTRUP, KEVIN M (MD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:RIGTRUP
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 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-342-5900
Mailing Address - Fax:615-342-5912
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-342-5900
Practice Address - Fax:615-342-5912
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3875061Medicaid
KY64338148Medicaid
TN3875061Medicaid
KY64338148Medicaid