Provider Demographics
NPI:1124256151
Name:ADOLF, KEVIN DALE (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DALE
Last Name:ADOLF
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 1:25223 132ND PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 LAKE SHORE PLZ
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6175
Practice Address - Country:US
Practice Address - Phone:425-822-4325
Practice Address - Fax:425-777-2111
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000232A213E00000X
WAPO60217479213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
281189OtherL&I
G8904738Medicare UPIN