Healthcare Provider Details

I. General information

NPI: 1972672491
Provider Name (Legal Business Name): KENNETH A SCHENKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

250 W 96TH ST STE 520
INDIANAPOLIS IN
46260-1317
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-6815
  • Fax: 317-338-8875
Mailing address:
  • Phone: 317-583-3444
  • Fax: 317-583-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD00027412
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: