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Individual

KENNETH A ORCHARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1035 VALLEY STREAM DR, PINGREE GROVE, IL 60140-9137
(615) 260-5205
Mailing address
1035 VALLEY STREAM DR, PINGREE GROVE, IL 60140-9137
(615) 260-5205

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28715
TN
2083X0100X
Occupational Medicine Physician
28715
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
103I082013
MEDICARE MCRPTAN
TN
Enumeration date
03/29/2007
Last updated
10/26/2018
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