Provider Demographics
NPI:1588744650
Name:PETERMANN, KEVIN LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LOUIS
Last Name:PETERMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3820 NORTHDALE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1893
Mailing Address - Country:US
Mailing Address - Phone:813-961-1331
Mailing Address - Fax:888-850-8316
Practice Address - Street 1:4700 W 95TH ST STE 303
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2572
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:888-812-8191
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036141794202K00000X, 207R00000X
NY232845207R00000X
FLME118086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLID666ZMedicare PIN