Provider Demographics
NPI:1750777066
Name:DO, KEVIN (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
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Last Name:DO
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Gender:M
Credentials:DO
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:IHA LAKE ORION PRIMARY CARE
Practice Address - Street 2:1375 S. LAPEER RD STE 210
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360
Practice Address - Country:US
Practice Address - Phone:248-693-5700
Practice Address - Fax:248-693-5715
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2022-11-04
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Provider Licenses
StateLicense IDTaxonomies
MI5101021949207Q00000X
ORDO194421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine