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General NPI Number Information
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NPI Number | 1427053255
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Entity Type | Individual
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Provider Name | KENNETH WAYNE BLUMENTHAL DO
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 2802 LEONARD DR
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City | VALPARAISO
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State | IN
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Zip | 46383-7136
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Country | US
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Telephone | 219-531-5855
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Fax | 219-531-1617
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Provider Business Mailing Address
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Address Line | 2802 LEONARD DR
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City | VALPARAISO
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State | IN
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Zip | 46383-7136
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Country | US
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Telephone | 219-531-5855
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Fax | 219-531-1617
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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 | 02000639
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License Number State | IN
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