Active NPI
Kevin Scott Myers, MD
- Dermatology Physician
- Sheboygan, WI
National Provider Identifier
1063486397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 24584
- Practice address
- 1440 N 25TH St
Sheboygan, WI 53081 - Phone
- (920) 457-9100
- Fax
- (920) 457-1461
- NPI assigned
- Feb 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 24584 | WI | Primary |
Addresses
Primary practice location
1440 N 25TH St
Sheboygan, WI 53081
Mailing address
1440 N 25TH St
Sheboygan, WI 53081
Phone (920) 457-9100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 391497952 | Other | WI | FEDERAL TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261440000000",
"number": "1063486397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 N 25TH ST",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "53081",
"telephone_number": "920-457-9100",
"fax_number": "920-457-1461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 N 25TH ST",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "53081",
"telephone_number": "920-457-9100",
"fax_number": "920-457-1461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYERS",
"first_name": "KEVIN",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2009-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "WI",
"license": "24584",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "391497952",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sheboygan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.