Individual
KEVIN GLEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 CRYSTAL SPRING AVE SW, ROANOKE, VA 24014-2462
(540) 981-7000
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5353
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9111118
FL
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
0110010529
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123109200
—
FL
01
—
MQH91
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/03/2017
Last updated
12/03/2024
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