Individual
KENNETH MASAKA KIGORWE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 MICHIGAN AVENUE, SUITE 240, LOGANSPORT, IN 46947-1530
(574) 753-4500
Mailing address
1201 MICHIGAN AVENUE, SUITE 240, LOGANSPORT, IN 46947-1530
(574) 753-4500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11013535A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000621189
ANTHEM
IN
05
—
200944250
—
IN
Enumeration date
08/05/2008
Last updated
07/26/2011
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