Provider Demographics
NPI:1871563023
Name:ALTEN, KEVIN W (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:W
Last Name:ALTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64979 OLD TWENTY ONE RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9619
Mailing Address - Country:US
Mailing Address - Phone:740-432-1050
Mailing Address - Fax:740-432-1070
Practice Address - Street 1:64979 OLD TWENTY ONE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9619
Practice Address - Country:US
Practice Address - Phone:740-432-1050
Practice Address - Fax:740-432-1070
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.067443CTR207V00000X
OH35067443A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2027550Medicaid
0835426Medicare ID - Type Unspecified
G62619Medicare UPIN
OH2027550Medicaid