Kenneth A Black in Portage - Family Medicine
Kenneth A Black - NPI 1134184112
Kenneth A Black is a Family Medicine in Portage, Indiana. Kenneth A Black practices all healthcare services and medical treatments related to Family Medicine. The NPI Number for Kenneth A Black is 1134184112. The last update date is 2008-02-15.
Kenneth A Black's current location address is 3630 Willowcreek Rd, Portage, Indiana. You can contact this provider via phone number 2197591157. The mailing address for Kenneth A Black is 3630 Willowcreek Rd, Portage, Indiana. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kenneth A Black |
|---|---|
| Address | 3630 Willowcreek Rd, Portage, Indiana |
| Phone Number | 2197591157 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1134184112 |
|---|---|
| Provider Enumeration Date | 2006-04-20 |
| Last Updated Date | 2008-02-15 |
Provider Mailing Address Detail
| Address | 3630 Willowcreek Rd |
|---|---|
| City | Portage |
| State | Indiana (IN) |
| Post Code | 463685075 |
| Phone Number | 2197591157 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Family Medicine |
|---|---|
| Taxonomy | 207Q00000X |
| Licence No | 1024841 |
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Definition: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine i |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 100207860A | IN | -- | |
| 521738 | IN | ANTHEM | |
| 5251392 | AETNA |
Post Comment/ Review Below
What is the unique provider identifier assigned to Kenneth A Black?
The Kenneth A Black has been issued the NPI (National Provider Identifier) 1134184112 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code is a unique identification number for healthcare providers.
Could you provide the complete address where Kenneth A Black is physically located?
The Kenneth A Black is situated at the following address: 3630 Willowcreek Rd, Portage, IN 463685075.
What is the Kenneth A Black's specialty and taxonomy code?
The Kenneth A Black's specialty is Family Medicine, and the corresponding taxonomy code is 207Q00000X.
On what date did the Kenneth A Black receive its 1134184112 assignment from the Centers for Medicare & Medicaid Services?
The Kenneth A Black was assigned its 1134184112 by the Centers for Medicare & Medicaid Services on 2006-04-20.
When was the information pertaining to Kenneth A Black most recently updated or revised?
The details related to Kenneth A Black, including its address, specialty, and other relevant information, were last updated or revised on 2008-02-15.