Provider Demographics
NPI: | 1659597136 |
---|---|
Name: | BAEHL, KEVIN PAUL (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | KEVIN |
Middle Name: | PAUL |
Last Name: | BAEHL |
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: | 1550 E REPUBLIC RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRINGFIELD |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65804-6530 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 417-889-6102 |
Mailing Address - Fax: | 417-889-6289 |
Practice Address - Street 1: | 3801 S NATIONAL AVE |
Practice Address - Street 2: | COX HOSPITAL-DEPT OF RADIOLOGY |
Practice Address - City: | SPRINGFIELD |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65807-5210 |
Practice Address - Country: | US |
Practice Address - Phone: | 417-269-4056 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-04-17 |
Last Update Date: | 2011-07-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35-094877 | 2085B0100X, 2085D0003X, 2085U0001X, 2085H0002X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0001X, 2085R0203X, 2085R0204X, 207U00000X, 207UN0903X, 207UN0902X, 207UN0901X |
MO | 2011009903 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No | 2085D0003X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
No | 2085H0002X | Allopathic & Osteopathic Physicians | Radiology | Hospice and Palliative Medicine |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No | 2085N0904X | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology |
No | 2085P0229X | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No | 2085R0203X | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | |
No | 207UN0903X | Allopathic & Osteopathic Physicians | Nuclear Medicine | In Vivo & In Vitro Nuclear Medicine |
No | 207UN0902X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Imaging & Therapy |
No | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 3047027 | Medicaid | |
OH | 3047027 | Medicaid | |
MO | 102420005 | Medicare PIN | |
OH | BA4289211 | Medicare PIN |