Individual
DR. KENNETH K MOGHADAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11725 N ILLINOIS ST, SUITE 515, CARMEL, IN 46032-3008
(317) 814-4110
(317) 814-4114
Mailing address
11725 N ILLINOIS ST, SUITE 515, CARMEL, IN 46032-3008
(317) 814-4110
(317) 814-4114
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
01051029A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000366889
ANTHEM
IN
Enumeration date
08/11/2006
Last updated
04/30/2010
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