Provider Demographics
NPI:1710916408
Name:PREWETT, KEVIN E (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:PREWETT
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:PO BOX 10583
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-0583
Mailing Address - Country:US
Mailing Address - Phone:251-435-2646
Mailing Address - Fax:251-435-6478
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-435-2646
Practice Address - Fax:251-435-6478
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.24589207P00000X, 208M00000X, 207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1710916408OtherTRICARE SOUTH
AL510-03483OtherBCBS
AL510-48740OtherBCBS
AL009938388Medicaid
AL515-97202OtherBCBS
AL009984160Medicaid
AL009991605Medicaid
AL510-01020OtherBCBS
AL009936036Medicaid
AL515-07857OtherBCBS
AL009936037Medicaid
AL009936038Medicaid
AL510-03492OtherBCBS
AL009984160Medicaid
AL510-48740OtherBCBS
AL510-03492OtherBCBS
AL051555857Medicare PIN