Individual
KEVIN BLASE DEANDRADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6701 AIRPORT BLVD, SUITE A-107, MOBILE, AL 36608-6774
(251) 433-4700
Mailing address
6701 AIRPORT BLVD, SUITE A-107, MOBILE, AL 36608-6774
(251) 433-4700
(251) 435-8549
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
30054
AL
207RI0011X
Interventional Cardiology Physician
Primary
30054
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063477644
—
AL
Enumeration date
05/28/2008
Last updated
05/06/2019
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