Provider Demographics
NPI:1740641851
Name:MIDDLEMIST, KEVIN MICHEL (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHEL
Last Name:MIDDLEMIST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1241 W STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6023
Mailing Address - Country:US
Mailing Address - Phone:573-635-8000
Mailing Address - Fax:573-556-1710
Practice Address - Street 1:1241 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6023
Practice Address - Country:US
Practice Address - Phone:573-635-8000
Practice Address - Fax:573-556-1710
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2023-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2022031059207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine