Provider Demographics
NPI:1144278029
Name:SATOW, KEVIN M (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:SATOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1144 SONOMA AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4812
Mailing Address - Country:US
Mailing Address - Phone:707-523-2070
Mailing Address - Fax:707-523-2037
Practice Address - Street 1:1144 SONOMA AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4812
Practice Address - Country:US
Practice Address - Phone:707-523-2070
Practice Address - Fax:707-523-2037
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG70506208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G705060Medicare ID - Type Unspecified
CAF40555Medicare UPIN