Basic Information
| Provider Information | |||||||||
| NPI: | 1427099670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANNAN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | L-3549 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837927 | ||||||||
| FaxNumber: | 7403837942 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 DELAWARE AVENUE | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433011814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403838047 | ||||||||
| FaxNumber: | 7403837942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 10/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35.046275 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0500473 | 01 | PALMETTO MEDICARE | OTHER | 000000118397 | 01 | OH | ANTHEM | OTHER | 353077 | 01 | SUBMITTER NO | OTHER | 311098079 | 01 | TAX ID | OTHER | 311098079 | 01 | TAX ID PHYSICIANS NONPHYS | OTHER | 0457867 | 05 | OH | MEDICAID | 060018891 | 01 | TRAVELERS MEDICARE | OTHER | 2500145 | 01 | UHC | OTHER | 311098079 | 01 | TAXID E | OTHER | 311098079056 | 01 | CIGNA | OTHER | 311098079 | 01 | PPO NEXT | OTHER | 643330 | 01 | AETNA | OTHER |