MEDICARE: DR. KENNETH R AUSTIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	15466R	LA
2	207L00000X	Anesthesiology Physician	01061694A	IN
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	01061694A	IN

General Provider Information

NPI Number	:	1366422529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH R AUSTIN M.D.

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11104 PARKVIEW CIRCLE DR STE 20
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1733
Country	:	US
Telephone Number	:	270-266-5370
Fax Number	:	260-266-5379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	06/25/2025

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