Individual
KENNETH WAYNE BLUMENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2802 LEONARD DR, VALPARAISO, IN 46383-7136
(219) 531-5855
(219) 531-1617
Mailing address
2802 LEONARD DR, VALPARAISO, IN 46383-7136
(219) 531-5855
(219) 531-1617
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000639
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000093874
AMTHEM BC/BS
IN
01
—
080152596
RAILROAD MEDICARE
IN
05
—
100352990
—
IN
Enumeration date
06/17/2005
Last updated
05/08/2024
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