Individual
KEN MONAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
1007 LINCOLNWAY, LA PORTE, IN 46350-3201
(219) 326-1234
Mailing address
6755 N STATE ROAD 23, WALKERTON, IN 46574-8323
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
31003890A
IN
Other
Enumeration date
06/21/2007
Last updated
07/08/2007
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