Individual
KENNETH RANDAL PEARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9880 ANGIES WAY STE 400, LOUISVILLE, KY 40241-2850
(502) 394-6500
(502) 394-1920
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 272-5395
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
39864
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000501261
ANTHEM
KY
01
—
50009443
PASSPORT HEALTH PLAN
KY
05
—
64115017
—
KY
Enumeration date
09/28/2006
Last updated
09/14/2021
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