Provider Demographics
NPI:1992810717
Name:MCDONALD, KEVIN C (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:MCDONALD
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 1:1022 LEE-ANN DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-886-1918
Mailing Address - Fax:704-257-2049
Practice Address - Street 1:1022 LEE ANN DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2911
Practice Address - Country:US
Practice Address - Phone:704-786-4482
Practice Address - Fax:704-786-0604
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC443213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01141570OtherRAILROAD
NC890811CMedicaid
NCNC8909B699Medicare PIN
NC6712460001Medicare NSC