Provider Demographics
NPI:1194126425
Name:MAIN, KEVIN B (PA-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:MAIN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3303 E BASELINE RD., STE #208
Mailing Address - Street 2:DESERT PULMONARY & SLEEP CONSULTANTS, PLC
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2738
Mailing Address - Country:US
Mailing Address - Phone:480-962-1650
Mailing Address - Fax:480-962-1883
Practice Address - Street 1:3303 E BASELINE RD., STE #208
Practice Address - Street 2:DESERT PULMONARY & SLEEP CONSULTANTS, PLC
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2738
Practice Address - Country:US
Practice Address - Phone:480-962-1650
Practice Address - Fax:480-962-1883
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
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Provider Licenses
StateLicense IDTaxonomies
AZ5638363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical