Individual
KEVIN MICHAEL CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 10TH STREET SE, CEDAR RAPIDS, IA 52403-2404
(319) 399-2022
(319) 399-2014
Mailing address
PO BOX 3178, CEDAR RAPIDS, IA 52406-3178
(319) 398-1583
(319) 399-2085
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
28759
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0219329
—
IA
01
—
22504
BLUE CROSS/BLUE SHIELD
IA
Enumeration date
05/10/2006
Last updated
09/11/2013
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