Individual
KEVIN M SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 MEMORIAL DR STE 312, SOUTH BEND, IN 46601-1073
(574) 647-5200
(574) 647-5210
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01044597A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200181930
—
IN
Enumeration date
09/14/2005
Last updated
04/05/2021
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