Individual
KENNETH PRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1710 LAFAYETTE RD, CRAWFORDSVILLE, IN 47933-1033
(765) 364-3151
(765) 364-8517
Mailing address
1710 LAFAYETTE RD, CRAWFORDSVILLE, IN 47933-1033
(765) 364-3151
(765) 364-8517
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01060295A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200541670
—
IN
Enumeration date
04/13/2007
Last updated
01/13/2009
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