Provider Demographics
NPI:1487644100
Name:GARREN, KURT CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:CHARLES
Last Name:GARREN
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 1:515 UNION AVE
Mailing Address - Street 2:SUITE 157
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622
Mailing Address - Country:US
Mailing Address - Phone:330-343-9600
Mailing Address - Fax:330-343-4410
Practice Address - Street 1:515 UNION AVE
Practice Address - Street 2:SUITE 157
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3004
Practice Address - Country:US
Practice Address - Phone:330-343-9600
Practice Address - Fax:330-343-4410
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072946207Y00000X
OH35-072946207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330776Medicaid
OH9383791Medicare PIN
OHG77239Medicare UPIN
OH2330776Medicaid
OH9328031Medicare PIN
OH4092071Medicare PIN