Individual
DR. GENA R KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 TEAL RD, SUITE 8, LAFAYETTE, IN 47905-2463
(765) 477-2020
(765) 477-8200
Mailing address
1400 TEAL RD, SUITE 8, LAFAYETTE, IN 47905-2463
(765) 477-2020
(765) 477-8200
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01054602A
IN
207WX0120X
Cornea and External Diseases Specialist Physician
01054602A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200349180
—
IN
Enumeration date
02/14/2006
Last updated
05/02/2018
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