Basic Information
| Provider Information | |||||||||
| NPI: | 1497722672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACHMAN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | GREGORY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1602 DOCTORS CIR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103438889 | ||||||||
| FaxNumber: | 9103439990 | ||||||||
| Practice Location | |||||||||
| Address1: | 1602 DOCTORS CIR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103438889 | ||||||||
| FaxNumber: | 9103439990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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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 | 213ES0103X | 449 | NC | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213EP1101X | 449 | NC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0131X | 449 | NC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | E1552 | 01 | NC | MEDCOST | OTHER | P00959570 | 01 | MEDICARE RAILROAD | OTHER | 0807N | 01 | NC | BCBS NC | OTHER | 890807N | 05 | NC | MEDICAID | E1550 | 01 | NC | MEDCOST | OTHER |