Provider Demographics
NPI:1013446079
Name:ROWE, KEVIN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ROWE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 N ABERDEEN ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6548
Mailing Address - Country:US
Mailing Address - Phone:312-479-4637
Mailing Address - Fax:
Practice Address - Street 1:5101 12TH ARMOR DIVISION AVE
Practice Address - Street 2:8-229TH ASSAULT HELICOPTER BATTALION HQ
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-2173
Practice Address - Country:US
Practice Address - Phone:312-479-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant