Provider Demographics
NPI:1497809669
Name:RULLMAN, KEVIN ARTHUR (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ARTHUR
Last Name:RULLMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6937
Mailing Address - Country:US
Mailing Address - Phone:907-714-4025
Mailing Address - Fax:907-335-0064
Practice Address - Street 1:506 LAKE ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6937
Practice Address - Country:US
Practice Address - Phone:907-714-4025
Practice Address - Fax:907-335-0064
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine