Healthcare Provider Details

I. General information

NPI: 1356835623
Provider Name (Legal Business Name): KENO CARTER-GUY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N SENATE AVE
INDIANAPOLIS IN
46202-2213
US

IV. Provider business mailing address

1520 N SENATE AVE
INDIANAPOLIS IN
46202-2213
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-4634
  • Fax:
Mailing address:
  • Phone: 317-963-4634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: