Individual
KENNETH PATRICK O'CONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 234-8161
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003872A
IN
363A00000X
Physician Assistant
99114487A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430H05
MEDICARE PTAN
IN
05
—
300074048
—
IN
Enumeration date
03/15/2022
Last updated
02/12/2025
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