Provider Demographics
NPI:1922146596
Name:FAJARDO, KEVIN ANTHONY (MD, MPH, MTMH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANTHONY
Last Name:FAJARDO
Suffix:
Gender:M
Credentials:MD, MPH, MTMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2771 HEMLOCK ST STE 100
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2689
Practice Address - Country:US
Practice Address - Phone:360-360-2763
Practice Address - Fax:360-707-7808
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142177207N00000X
IN01061083A2083P0901X
CO0061102208D00000X
WAMD61301063207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice