| Doctor Name: | KENNETH A. GARDNER |
| NPI Number: | 1710976352 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 22049 |
| Business Practice Address: | 150 Fairview Court Eminence, KY - 40019 |
| Business Phone Number: | 5028455672 |
| Business Fax Number: | 5028451402 |
| Mailing Address: | 6801 Dixie Hwy, Ste 130 LOUISVILLE |
| State: | KY |
| Postal Code: | 402583913 |
| Phone Number: | 5026333525 |
| Fax Number: | 5026334067 |
| NPI Enumeration Date: | 10/17/2005 |
| NPI Last Update Date: | 11/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 22049 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |