Individual
DR. KENN VATTATHARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
720 45TH ST, MUNSTER, IN 46321-2818
(219) 852-2513
(219) 852-2443
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01095510A
IN
2084P0800X
Psychiatry Physician
036172806
IL
Other
Enumeration date
05/03/2021
Last updated
07/24/2025
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