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General NPI Number Information
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NPI Number | 1376621771
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Entity Type | Organization
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Legal Business Name | KENNETH R. HAUSWALD
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 400 SAINT CHRISTOPHER DR
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City | ASHLAND
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State | KY
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Zip | 41101-7022
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Country | US
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Telephone | 606-833-0088
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Fax | 606-833-0130
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Provider Business Mailing Address
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Address Line | 400 SAINT CHRISTOPHER DR
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City | ASHLAND
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State | KY
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Zip | 41101-7022
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Country | US
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Telephone | 606-833-0088
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Fax | 606-833-0130
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH R HAUSWALD
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Credential | M.D.
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Telephone | 606-920-9813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 16406
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License Number State | KY
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