Individual
DR. KENNETH WESLEY OGLESBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
583 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5515
(812) 355-6933
Mailing address
995 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5588
(812) 355-6933
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000932A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000256323
BCBS
IN
05
—
200347640
—
IN
Enumeration date
09/26/2006
Last updated
12/18/2020
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