Provider Demographics
NPI:1063408177
Name:HILL, KEVIN K (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:HILL
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 1:201 DUEBER AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-1164
Mailing Address - Country:US
Mailing Address - Phone:330-453-4000
Mailing Address - Fax:330-456-2866
Practice Address - Street 1:201 DUEBER AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-1164
Practice Address - Country:US
Practice Address - Phone:330-453-4000
Practice Address - Fax:330-456-2866
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071991H207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110178787OtherRAILROAD MEDICARE
OH2088575Medicaid
OH2088575Medicaid
G78355Medicare UPIN