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Individual

KENNETH M SPICKLEMIRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4601 S 7TH ST, TERRE HAUTE, IN 47802-4522
(812) 232-3281
(812) 235-3758
Mailing address
221 S 6TH ST, TERRE HAUTE, IN 47807-4214
(812) 232-3281
(812) 235-3758

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028691A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000089619
ANTHEM
01
080000130
RAILROAD MCARE PALAMETTO
05
100250990
IN
05
100250990Q
IN
05
100250990R
IN
01
P00834942
RAILROAD MEDICARE
IN
Enumeration date
08/30/2006
Last updated
08/18/2010
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