Provider Demographics
NPI:1649279274
Name:THOMPSON, KEVIN E (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2401
Mailing Address - Country:US
Mailing Address - Phone:319-671-2939
Mailing Address - Fax:
Practice Address - Street 1:81 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2401
Practice Address - Country:US
Practice Address - Phone:931-967-1293
Practice Address - Fax:847-669-2980
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66958207R00000X
IL036-083414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532206OtherBLUE CROSS BLUE SHIELD
IL036083414Medicaid
IL04532206OtherBLUE CROSS BLUE SHIELD
IL036083414Medicaid
ILP00184995Medicare PIN
ILK11093Medicare PIN
ILK11094Medicare PIN