Individual
MR. KENNETH WILLOUGHBY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
32051 GROVE ST, AVON LAKE, OH 44012-1906
(440) 930-2802
Mailing address
32051 GROVE ST, AVON LAKE, OH 44012-1906
(440) 930-2802
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4370
SC
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
08/16/2007
Last updated
05/06/2025
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