Individual
KENNETH LEE ODER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12615 TAYLORSVILLE RD, LOUISVILLE, KY 40299-4452
(502) 261-1595
(502) 261-1590
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25195
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64251952
—
KY
Enumeration date
06/30/2005
Last updated
07/13/2016
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