Healthcare Provider Details

I. General information

NPI: 1457556920
Provider Name (Legal Business Name): KENNETH M FINK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 SIXTH AVENUE
HUNTINGTON WV
25701
US

IV. Provider business mailing address

PO BOX 2282
HUNTINGTON WV
25724-2282
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-8191
  • Fax:
Mailing address:
  • Phone: 304-525-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9624
License Number StateWV

VIII. Authorized Official

Name: KENNETH M FINK
Title or Position: PRESIDENT
Credential: MD
Phone: 304-525-8191