Basic Information
| Provider Information | |||||||||
| NPI: | 1114125168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEI | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3702 NEW VISION DR BLDG B | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2602668210 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11141 PARKVIEW PLAZA DR STE 305 | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2602668900 | ||||||||
| FaxNumber: | 2602668935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MDR5312 | HI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | R8806 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 052978 | CT | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | ME141652 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 01083968 | IN | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.