Healthcare Provider Details

I. General information

NPI: 1891322509
Provider Name (Legal Business Name): KENNETH AUSTIN FURLOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

IV. Provider business mailing address

12114 S EDBROOKE AVE
CHICAGO IL
60628-6633
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3940
  • Fax: 617-667-2115
Mailing address:
  • Phone: 773-517-2343
  • 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
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number3020173
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: