Individual
KENNETH MITCHUM MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1045 WYATT WAY, LIZTON, IN 46149-9583
(317) 994-6600
(317) 994-6605
Mailing address
1100 SOUTHFIELD DR, SUITE 1370, PLAINFIELD, IN 46168-4498
(317) 837-5571
(317) 837-5580
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000836A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200932990
—
IN
Enumeration date
07/26/2006
Last updated
03/08/2021
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