Provider Demographics
NPI:1811157654
Name:MCDONNELL, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MCDONNELL
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 1:224 W EXCHANGE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1726
Mailing Address - Country:US
Mailing Address - Phone:330-344-7040
Mailing Address - Fax:330-344-1714
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1726
Practice Address - Country:US
Practice Address - Phone:330-344-7040
Practice Address - Fax:330-344-1714
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-096705207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01073771OtherRR MEDICARE
OH0052039Medicaid
OH000000727394OtherANTHEM
OHH007100Medicare PIN