Provider Demographics
NPI:1831136779
Name:CAZAN-LONDON, KEVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:CAZAN-LONDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:MICHAEL
Other - Last Name:LONDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1560 TURF LN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6392
Mailing Address - Country:US
Mailing Address - Phone:517-484-3000
Mailing Address - Fax:517-484-6358
Practice Address - Street 1:1560 TURF LN
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6392
Practice Address - Country:US
Practice Address - Phone:517-484-3000
Practice Address - Fax:517-484-6358
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076238207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2491718Medicaid
OH2491718Medicaid