Provider Demographics
NPI:1427099670
Name:KANNAN, KEVIN R (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:KANNAN
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:L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43301-1814
Practice Address - Country:US
Practice Address - Phone:740-383-8047
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.046275207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0500473OtherPALMETTO MEDICARE
OH000000118397OtherANTHEM
353077OtherSUBMITTER NO
311098079OtherTAX ID
311098079OtherTAX ID PHYSICIANS NONPHYS
OH0457867Medicaid
060018891OtherTRAVELERS MEDICARE
2500145OtherUHC
311098079OtherTAXID E
311098079056OtherCIGNA
311098079OtherPPO NEXT
643330OtherAETNA
0500473OtherPALMETTO MEDICARE
2500145OtherUHC
OHH144470Medicare PIN