Provider Demographics
NPI:1588670566
Name:KLEINSCHMIDT, KEVIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:KLEINSCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-2755
Mailing Address - Country:US
Mailing Address - Phone:870-898-5037
Mailing Address - Fax:870-898-4732
Practice Address - Street 1:418 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-2755
Practice Address - Country:US
Practice Address - Phone:870-898-5037
Practice Address - Fax:870-898-4732
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR861079386OtherTAX #
ARP00052246OtherRAILROAD MCR
ARAP.220001OtherTRICARE
AR04D0953144OtherCLIA
AR12715600100Medicaid
AR5J650OtherBLUE CROSS
ARP00649786OtherMEDICARE RAILROAD CARRIER
AR861079386OtherTAX #
ARP00649786OtherMEDICARE RAILROAD CARRIER