Provider Demographics
NPI:1457358137
Name:MOLAN, KEVIN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:MOLAN
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 1:10370 PARK RD
Mailing Address - Street 2:200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8508
Mailing Address - Country:US
Mailing Address - Phone:704-054-2825
Mailing Address - Fax:
Practice Address - Street 1:10370 PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8508
Practice Address - Country:US
Practice Address - Phone:704-542-8253
Practice Address - Fax:704-541-0186
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890804WMedicaid
NC890804WMedicaid
243154AMedicare PIN