Individual
KENNETH W BROCK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-8166
Mailing address
20 PRESTIGE PLZ, SUITE 100, MIAMISBURG, OH 45342-5354
(937) 436-4658
(937) 436-4984
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
35037259
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0251614
—
OH
Enumeration date
12/22/2005
Last updated
07/08/2007
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