Individual
KENNETH ADAM MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
355 W 16TH ST STE 5100, INDIANAPOLIS, IN 46202-2274
(317) 963-1300
(317) 222-2012
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
01090436A
IN
207T00000X
Neurological Surgery Physician
65489
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010906
MEDICARE PTAN
IN
05
—
300077297
—
IN
05
—
Q043273
—
TN
Enumeration date
04/16/2015
Last updated
10/02/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us