Individual
KEN O RIDGEWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
712 W MAIN ST, GREENTOWN, IN 46936-1045
(765) 628-3319
(765) 628-5979
Mailing address
712 W MAIN ST, GREENTOWN, IN 46936-1045
(765) 628-3319
(765) 628-5979
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2000340
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183513
ANTHEM
—
05
—
100186930A
—
IN
01
—
10825830
CAQH
—
Enumeration date
11/09/2005
Last updated
10/24/2007
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