Provider Demographics
NPI:1487771473
Name:UREN, KEVIN SCOTT (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
Last Name:UREN
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 1:32910 WEST 13 MILE RD
Mailing Address - Street 2:SUITE C300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1983
Mailing Address - Country:US
Mailing Address - Phone:248-996-1020
Mailing Address - Fax:248-996-1023
Practice Address - Street 1:508 MEETING ST
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7535
Practice Address - Country:US
Practice Address - Phone:727-796-6900
Practice Address - Fax:727-669-8417
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL138213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358791701Medicaid
TXP01675624OtherRAILROAD MEDICARE
SCPD7647Medicaid
TX358791701Medicaid
TXP01675624OtherRAILROAD MEDICARE
AL000074605Medicare ID - Type Unspecified