Provider Demographics
NPI:1528007754
Name:SHARRETT, KEVIN L (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:SHARRETT
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 1:50 N PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2666
Mailing Address - Country:US
Mailing Address - Phone:937-675-2870
Mailing Address - Fax:937-675-2873
Practice Address - Street 1:50 N PROGRESS DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2666
Practice Address - Country:US
Practice Address - Phone:937-675-2870
Practice Address - Fax:937-675-2873
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.063798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0891281Medicaid
F37430Medicare UPIN
OH0724764Medicare PIN
OH0891281Medicaid