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NPI Code Detail

MEDICARE: KENNETH E GREEN MD

MEDICARE: KENNETH E GREEN MD
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
1208600000XSurgery Physician24940KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508802950
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH E GREEN MD
Provider Business Mailing Address
First Line : 2700 STANLEY GAULT PKWY STE 129
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-5176
Country : US
Telephone Number : 502-489-6613
Fax Number : 502-489-5751
Provider Business Practice Location Address
First Line : 1025 NEW MOODY LN
Second Line :
City : LA GRANGE
State : KY
Zip : 40031-9154
Country : US
Telephone Number : 502-222-0598
Fax Number : 502-222-7446
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 05/02/2019

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Directions to “ KENNETH E GREEN MD” Practice Location

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