Individual
DR. KEVIN D MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 MEDICAL VILLAGE DR STE 254, EDGEWOOD, KY 41017-5401
(859) 344-1600
(859) 344-0091
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 344-1600
(859) 344-0091
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
26395
KY
208600000X
Surgery Physician
26395
KY
2086S0129X
Vascular Surgery Physician
01072246A
IN
2086S0129X
Vascular Surgery Physician
Primary
26395
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660100
—
OH
05
—
100354190A
—
IN
05
—
64788912
—
KY
05
—
7100056850
—
KY
01
—
770000278
RAILROAD MEDICARE
OH
01
—
P00252697
RAILROAD MEDICARE
KY
Enumeration date
08/22/2005
Last updated
08/04/2021
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