Provider Demographics
NPI:1205889433
Name:KAVANAUGH, KEVIN M (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:KAVANAUGH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W 7TH AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2349
Mailing Address - Country:US
Mailing Address - Phone:509-838-7711
Mailing Address - Fax:509-747-4664
Practice Address - Street 1:122 W 7TH AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2349
Practice Address - Country:US
Practice Address - Phone:509-838-7711
Practice Address - Fax:509-747-4664
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD31738207RC0000X
WAMD00031738207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM6627OtherIDAHO LICENSE
WAMD00031738OtherWASHINGTON LICENSE
ID003213300Medicaid
IDM6627OtherIDAHO LICENSE