Individual
KENNETH W ABBOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2222 W LEXINGTON AVE, ELKHART, IN 46514-1420
(574) 294-3030
(574) 294-3544
Mailing address
PO BOX 2968, ELKHART, IN 46515-2968
(574) 296-3200
(574) 296-3544
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0102595A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112470
—
IN
01
—
180041763
RAILROAD MEDICARE
IN
Enumeration date
10/18/2006
Last updated
01/08/2016
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