Provider Demographics
NPI:1508848524
Name:KRUMVIEDA, KEVIN LOUIS (PHD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LOUIS
Last Name:KRUMVIEDA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1408
Mailing Address - Country:US
Mailing Address - Phone:319-365-3993
Mailing Address - Fax:319-364-0116
Practice Address - Street 1:1730 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5433
Practice Address - Country:US
Practice Address - Phone:319-365-3993
Practice Address - Fax:319-364-0116
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12920OtherMIDLANDS CHOICE
IA42-0926783-14OtherUNITED BEHAVIORAL HEALTH
IA58523Medicare ID - Type Unspecified
IA42-0926783-14OtherUNITED BEHAVIORAL HEALTH