Individual
KENNETH E GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 NEW MOODY LN, LA GRANGE, KY 40031-9154
(502) 222-0598
(502) 222-7446
Mailing address
2700 STANLEY GAULT PKWY STE 129, LOUISVILLE, KY 40223-5176
(502) 489-6613
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
24940
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6424940200
—
KY
Enumeration date
06/22/2006
Last updated
05/02/2019
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