Provider Demographics
NPI:1497722672
Name:BACHMAN, KEVIN GREGORY (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GREGORY
Last Name:BACHMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 DOCTORS CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7406
Mailing Address - Country:US
Mailing Address - Phone:910-343-8889
Mailing Address - Fax:910-343-9990
Practice Address - Street 1:1602 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7406
Practice Address - Country:US
Practice Address - Phone:910-343-8889
Practice Address - Fax:910-343-9990
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC449213ES0103X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE1552OtherMEDCOST
P00959570OtherMEDICARE RAILROAD
NC0807NOtherBCBS NC
NC890807NMedicaid
NCE1550OtherMEDCOST
NC0807NOtherBCBS NC
NCE1550OtherMEDCOST