Provider Demographics
NPI:1932106465
Name:O'KOON, KEVIN A (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:O'KOON
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 1:3900 KRESGE WAY STE 44
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4681
Mailing Address - Country:US
Mailing Address - Phone:502-897-6700
Mailing Address - Fax:
Practice Address - Street 1:3900 KRESGE WAY STE 44
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4681
Practice Address - Country:US
Practice Address - Phone:502-897-6700
Practice Address - Fax:502-897-6704
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33122208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000189866OtherANTHEM FACET NUMBER
KY1054637Medicaid
KY64331226Medicaid
KY64331226Medicaid
KY0918301Medicare ID - Type Unspecified
KYP00136419Medicare ID - Type UnspecifiedRAILROAD MEDICARE