Healthcare Provider Details

I. General information

NPI: 1003994310
Provider Name (Legal Business Name): KENNETH N SCHIKLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E CHESTNUT ST # STREET3
LOUISVILLE KY
40202-1713
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-4910
  • Fax: 502-588-9554
Mailing address:
  • Phone: 502-559-9529
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16806
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number16806
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: