Provider Demographics
NPI:1811658420
Name:DONNELLY, KEVIN (PA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:26863 CARRONADE DR APT 8103
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6432
Mailing Address - Country:US
Mailing Address - Phone:517-918-3072
Mailing Address - Fax:
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2598
Practice Address - Country:US
Practice Address - Phone:419-383-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant