Provider Demographics
NPI:1396716221
Name:MULVEY, KEVIN JON (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JON
Last Name:MULVEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3032
Mailing Address - Country:US
Mailing Address - Phone:641-792-6446
Mailing Address - Fax:641-792-3556
Practice Address - Street 1:204 N 2ND AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3032
Practice Address - Country:US
Practice Address - Phone:641-792-6446
Practice Address - Fax:641-792-3556
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00607213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
41080OtherWELLMARK BCBS
IA1396716221Medicaid
IA480026192OtherRR MEDICARE
IA480025449OtherRR MEDICARE
41490OtherWELLMARK BCBS
42144062501OtherJOHN DEERE HEALTH CARE
42144062504OtherJOHN DEERE HEALTH CARE
IA1396716221Medicaid
41080Medicare ID - Type Unspecified
42144062501OtherJOHN DEERE HEALTH CARE
41490OtherWELLMARK BCBS
IA3951780001Medicare NSC