Provider Demographics
NPI:1396960035
Name:PURGIEL, KEVIN PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:PURGIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:421 SEWELL DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1223
Mailing Address - Country:US
Mailing Address - Phone:931-738-4395
Mailing Address - Fax:931-738-4330
Practice Address - Street 1:439 SEWELL DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1223
Practice Address - Country:US
Practice Address - Phone:931-837-0837
Practice Address - Fax:931-837-0838
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015467208600000X
TN2094208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519997Medicaid
TN103I028800Medicare PIN