Doctor Name: | DR. KEVIN C BRYANT |
NPI Number: | 1285949925 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | 00368 |
Business Practice Address: | 2300 Chamber Center Dr Suite 100 Lakeside Park, KY - 410171673 |
Business Phone Number: | 8593312440 |
Business Fax Number: | 8596890017 |
Mailing Address: | Po Box 636389, CINCINNATI |
State: | OH |
Postal Code: | 452630001 |
Phone Number: | 8593312440 |
Fax Number: | 8596890017 |
NPI Enumeration Date: | 08/17/2010 |
NPI Last Update Date: | 02/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 00368 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KY |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |