Individual
KEVIN L PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
442 W HIGH ST STE 3, BRYAN, OH 43506-1681
(419) 636-4517
(419) 636-6438
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-055915
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080059933
RAILROAD
OH
05
—
0878386
—
OH
Enumeration date
06/30/2006
Last updated
03/29/2023
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