Individual
MR. KENNETH A YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
503 GREENWOOD TRACE DR, WHITELAND, IN 46184-9278
(317) 535-7447
Mailing address
503 GREENWOOD TRACE DR, WHITELAND, IN 46184-9278
(317) 535-7447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01034419A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000083211
BLUE CROSS/BLUE SHIELD IN
IN
05
—
100226250A
—
IN
Enumeration date
08/04/2005
Last updated
11/30/2021
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