Provider Demographics
NPI:1801888219
Name:MARTIN, KEVIN D (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:MARTIN
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-1600
Mailing Address - Fax:859-344-0091
Practice Address - Street 1:20 MEDICAL VILLAGE DR STE 254
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-344-1600
Practice Address - Fax:859-344-0091
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26395174400000X, 208600000X, 2086S0129X
IN01072246A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100354190AMedicaid
KYP00252697OtherRAILROAD MEDICARE
OH00660100Medicaid
OH770000278OtherRAILROAD MEDICARE
KY64788912Medicaid
KY7100056850Medicaid
KY0655053Medicare PIN
KY7100056850Medicaid
KY1459510Medicare PIN
KY3400135Medicare PIN
C03191Medicare UPIN
IN100354190AMedicaid
P00234040Medicare PIN
KYP00252697Medicare PIN