MEDICARE: KENNETH A ORCHARD 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	2083X0100X	Occupational Medicine Physician	28715	TN
2	207Q00000X	Family Medicine Physician	28715	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103I082013	OTHER	TN	MEDICARE MCRPTAN

General Provider Information

NPI Number	:	1891814653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH A ORCHARD M.D.

Provider Business Mailing Address
First Line	:	1035 VALLEY STREAM DR
Second Line	:
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-9137
Country	:	US
Telephone Number	:	615-260-5205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 VALLEY STREAM DR
Second Line	:
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-9137
Country	:	US
Telephone Number	:	615-260-5205
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/26/2018

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Directions to “ KENNETH A ORCHARD M.D.” Practice Location

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