Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MDR5312 | HI |
N | 208600000X | Surgeon | MDR5312 | HI |
Y | 2086S0102X | Surgical Critical Care | 01083968 | IN |
N | 2086S0102X | Surgical Critical Care | 052978 | CT |
N | 2086S0102X | Surgical Critical Care | ME141652 | FL |
N | 2086S0102X | Surgical Critical Care | R8806 | TX |
NPI | 1114125168 |
---|---|
Provider Name | Kevin Y Pei |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Fort Wayne, IN 46845-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 10/09/2020 |