Provider Demographics
NPI:1265410377
Name:MCGANN, KEVIN TERRENCE (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:TERRENCE
Last Name:MCGANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5454 NEW CUT RD
Mailing Address - Street 2:STE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4271
Mailing Address - Country:US
Mailing Address - Phone:502-361-9900
Mailing Address - Fax:502-361-9947
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4421
Practice Address - Fax:502-587-4840
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY17398207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000057678OtherANTHEM OF KENTUCKY
KY64173982Medicaid
930059278OtherRAILROAD MEDICARE
IN200206810AOtherMEDICAID
029882600OtherFEDERAL BLACK LUNG
KY1061411OtherPASSPORT
D61795Medicare UPIN
KY64173982Medicaid