Provider Demographics
NPI:1619166675
Name:MARCUM, KEVIN W (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:W
Last Name:MARCUM
Suffix:
Gender:
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:PO BOX 919379
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9379
Mailing Address - Country:US
Mailing Address - Phone:844-453-1406
Mailing Address - Fax:772-621-3180
Practice Address - Street 1:1200 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1300
Practice Address - Country:US
Practice Address - Phone:727-825-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171342085R0202X
MO20200392652085R0202X
GUMC-1792085R0202X
FLME1102342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14F8GOtherFL BCBS
FL003839900Medicaid
FLFF900ZOtherFL MEDICARE
FLP01049403OtherFL RAILROAD MEDICARE PTAN