Provider Demographics
NPI:1851384846
Name:HENZEL, KEVIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:HENZEL
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 1:14210 SCOTTSLAWN RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43041-0001
Mailing Address - Country:US
Mailing Address - Phone:937-578-4288
Mailing Address - Fax:937-578-2642
Practice Address - Street 1:14210 SCOTTSLAWN RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43041-0001
Practice Address - Country:US
Practice Address - Phone:937-578-4288
Practice Address - Fax:937-578-2642
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083208207RH0002X
OH35083208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2511320Medicaid
OH2511320Medicaid
OHI10206Medicare UPIN