Provider Demographics
NPI:1467417964
Name:CARR, KEVIN G (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:CARR
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 1:1450 EASTSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-9800
Mailing Address - Country:US
Mailing Address - Phone:608-348-4330
Mailing Address - Fax:608-342-4801
Practice Address - Street 1:1450 EASTSIDE RD
Practice Address - Street 2:STE 110
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-9800
Practice Address - Country:US
Practice Address - Phone:608-348-4330
Practice Address - Fax:608-342-4810
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28636-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31468800Medicaid
WI1000595OtherPHYSICIANS PLUS
IA0592402Medicaid
WI31468800Medicaid
IA0592402Medicaid
E44015Medicare UPIN
IA0592402Medicaid