Individual
KENNETH E GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1895 ELIZABETHTOWN RD, LEITCHFIELD, KY 42754-9138
(270) 230-0182
(270) 230-0014
Mailing address
908 WALLACE AVE, LEITCHFIELD, KY 42754-1479
(270) 259-1626
(270) 259-9582
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23924
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1064549
PASSPORT HEALTH PLAN
KY
01
—
2434453000
PASSPORT ADVANTAGE
KY
05
—
64239247
—
KY
Enumeration date
08/05/2006
Last updated
12/10/2018
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