Individual
BENNY SP KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3660 GUION RD, STE 101, INDIANAPOLIS, IN 46222-1616
(317) 920-7139
(317) 920-7229
Mailing address
PO BOX 637999, CINCINNATI, OH 45263-7999
(317) 682-2030
(317) 644-5060
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01024080A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000703094
ANTHEM
IN
05
—
100381260A
—
IN
01
—
P00960535
RR MEDICARE
IN
Enumeration date
03/08/2007
Last updated
03/15/2013
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