Individual
DR. KENNETH DANIEL SHIVELY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 I ST, LAPORTE, IN 46350-5533
(219) 324-1950
Mailing address
328 N MICHIGAN ST, STE. 200, SOUTH BEND, IN 46601-1244
(574) 647-1845
(574) 647-1825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01024055A
IN
Other
Enumeration date
11/30/2005
Last updated
07/08/2007
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