Provider Demographics
NPI:1770553232
Name:MCGARVEY, KEVIN PAUL (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:MCGARVEY
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:PO BOX 5005
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875
Mailing Address - Country:US
Mailing Address - Phone:419-342-6351
Mailing Address - Fax:419-347-1697
Practice Address - Street 1:110 W SMILEY AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875
Practice Address - Country:US
Practice Address - Phone:419-342-6351
Practice Address - Fax:419-347-1697
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2944213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0240073Medicaid
OH480020566OtherRAILROAD MEDICARE
OH0240073Medicaid
MC0802281Medicare ID - Type Unspecified