Provider Demographics
NPI:1184710881
Name:SHALKHAM, KEVIN Q (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:Q
Last Name:SHALKHAM
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:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5535 PLATT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7519
Practice Address - Country:US
Practice Address - Phone:803-951-1880
Practice Address - Fax:803-951-0384
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC288496Medicaid
SC288496Medicaid
SCI332036201Medicare PIN
SCI332034713Medicare PIN
SCI332032461Medicare PIN
SCI332036126Medicare PIN
SCI332036125Medicare PIN