Provider Demographics
NPI:1902833296
Name:MCCHORD, KEVIN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:MCCHORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5500 MARYLAND WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4973
Mailing Address - Country:US
Mailing Address - Phone:844-407-7557
Mailing Address - Fax:
Practice Address - Street 1:4600 HOUSTON ROAD
Practice Address - Street 2:BUILDING #2/1ST FLOOR
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-283-3613
Practice Address - Fax:859-283-3712
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35072610207Q00000X
KY31649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDO6570OtherGROUP MEDICARE RAILROAD PTAN
OH9379701OtherGROUP MEDICARE PTAN
OHP00697138OtherINDIVIDUAL MEDICARE RAILROAD PTAN
OHDO6570OtherGROUP MEDICARE RAILROAD PTAN
OHP00697138OtherINDIVIDUAL MEDICARE RAILROAD PTAN