Doctor Name: | KENNETH L PENNINGTON |
NPI Number: | 1144200684 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 01024970 |
Business Practice Address: | 200 High Park Ave Goshen, IN - 465264810 |
Business Phone Number: | 5745352888 |
Business Fax Number: | |
Mailing Address: | 200 High Park Ave, GOSHEN |
State: | IN |
Postal Code: | 465264810 |
Phone Number: | 5745352888 |
Fax Number: | |
NPI Enumeration Date: | 01/19/2006 |
NPI Last Update Date: | 03/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 01024970 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |