Individual
KENNETH MACKINLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1373 E STATE ROAD 62 STE 2A, MADISON, IN 47250-7328
(812) 801-0848
(812) 801-0773
Mailing address
620 W MAIN ST, MADISON, IN 47250-3719
(440) 725-8373
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01081566A
IN
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
01081566A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30021835
—
IN
05
—
7100363840
—
KY
Enumeration date
04/15/2014
Last updated
06/02/2025
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