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General NPI Number Information
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NPI Number | 1013998723
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Entity Type | Individual
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Provider Name | KEN O RIDGEWAY DO
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 712 W MAIN ST
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City | GREENTOWN
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State | IN
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Zip | 46936-1045
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Country | US
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Telephone | 765-628-3319
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Fax | 765-628-5979
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Provider Business Mailing Address
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Address Line | 712 W MAIN ST
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City | GREENTOWN
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State | IN
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Zip | 46936-1045
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Country | US
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Telephone | 765-628-3319
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Fax | 765-628-5979
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2000340
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License Number State | IN
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