Provider Demographics
NPI:1750382602
Name:FLEAGLE, KURT ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:ANDREW
Last Name:FLEAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 FAR HILLS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2353
Mailing Address - Country:US
Mailing Address - Phone:937-434-4775
Mailing Address - Fax:937-434-4779
Practice Address - Street 1:5250 FAR HILLS AVE STE 210
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2353
Practice Address - Country:US
Practice Address - Phone:937-434-4775
Practice Address - Fax:833-450-5129
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH352238745001OtherMEDICAL MUTUAL
OH0264904Medicaid
OH000000348732OtherANTHEM
OHG38220Medicare UPIN
OH352238745001OtherMEDICAL MUTUAL