Provider Demographics
NPI:1578290573
Name:STEIN, KEVIN ANDREW
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ANDREW
Last Name:STEIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 E 400 N APT 106
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1514
Mailing Address - Country:US
Mailing Address - Phone:843-472-8237
Mailing Address - Fax:
Practice Address - Street 1:955 N COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1501
Practice Address - Country:US
Practice Address - Phone:330-616-3900
Practice Address - Fax:330-975-8676
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50007906RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0031881Medicaid