Provider Demographics
NPI:1982660346
Name:STEVENSON, KEVIN M (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:STEVENSON
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 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-522-0190
Mailing Address - Fax:808-523-9068
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2306
Practice Address - Country:US
Practice Address - Phone:808-522-0190
Practice Address - Fax:808-523-9068
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD128462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0246627OtherHMSA
HI550211-02OtherST DEPT OF PUB SAFETY
HIP00173080OtherPALMETTO GBA
HI108-2145098OtherAETNA
HI201243800OtherUS LABOR DEPT
HI508528OtherHI ELEC
HI550211-01OtherST DEPT OF PUB SAFETY
HI0055021101Medicaid
HI0055021102Medicaid
HI990157698OtherAETNA, UHC, CIGNA
HI990157698-96701-B013OtherTRICARE
HI7698147OtherUHA
HI00B0246625OtherHMSA
HI990157698-96817-B011OtherTRICARE
HI103802483OtherUS MARSHALL SVC-FED DET C
HIMD12846OtherQUEENS HEALTHCARE
HI00A0246627OtherHMSA
HI508528OtherHI ELEC