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General NPI Number Information
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NPI Number | 1164509535
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Entity Type | Individual
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Provider Name | EBENEZER KIO MD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 200 HIGH PARK AVE
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City | GOSHEN
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State | IN
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Zip | 46526-4810
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Country | US
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Telephone | 574-364-2888
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Fax | 574-364-2480
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Provider Business Mailing Address
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Address Line | 200 HIGH PARK AVE
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City | GOSHEN
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State | IN
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Zip | 46526-4810
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Country | US
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Telephone | 574-364-2888
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Fax | 574-364-2480
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 01066705A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036169262
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License Number State | IL
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