Provider Demographics
NPI:1255400750
Name:PREUSS, KEVIN CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:PREUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2325 18TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5387
Mailing Address - Country:US
Mailing Address - Phone:812-379-2020
Mailing Address - Fax:812-378-8267
Practice Address - Street 1:2325 18TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5387
Practice Address - Country:US
Practice Address - Phone:812-379-2020
Practice Address - Fax:812-378-8267
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01037349A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000088176OtherANTHEM BCBS
IN010712POtherSIHO
KY64875107OtherKENTUCKY MEDICAID
IN054770BMedicare ID - Type Unspecified
IN192390BMedicare ID - Type Unspecified
KY64875107OtherKENTUCKY MEDICAID