Individual
KENNETH L PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 HIGH PARK AVE, GOSHEN, IN 46526-4810
(574) 535-2888
Mailing address
3702 NEW VISION DR, BLDG B, FORT WAYNE, IN 46845-1703
(260) 266-8210
(574) 364-2759
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01024970
IN
207RX0202X
Medical Oncology Physician
Primary
01024970A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100138820
—
IN
Enumeration date
01/19/2006
Last updated
03/11/2019
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