Individual
KEVIN J WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2201 LEXINGTON AVE, ASHLAND, KY 41101-2843
(606) 408-4000
(606) 408-7426
Mailing address
P.O. BOX 2379, ASHLAND, KY 41105-2379
(606) 408-6200
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25530
KY
207Q00000X
Family Medicine Physician
35.053911
OH
208M00000X
Hospitalist Physician
25530
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000161894
ANTHEM
KY
05
—
0628922
—
OH
05
—
3810010701
—
WV
05
—
64255300
—
KY
Enumeration date
03/13/2007
Last updated
04/07/2017
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