Healthcare Provider Details

I. General information

NPI: 1366434375
Provider Name (Legal Business Name): KENNETH A TURK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/03/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 BRIGHAM DR STE 240
PERRYSBURG OH
43551-7124
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-872-7700
  • Fax: 419-874-0196
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35078516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: