Provider Demographics
NPI:1538168430
Name:NACHTNEBEL, KENNETH L (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:NACHTNEBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 MARY ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1677
Mailing Address - Country:US
Mailing Address - Phone:812-424-8231
Mailing Address - Fax:812-421-7032
Practice Address - Street 1:520 MARY ST
Practice Address - Street 2:SUITE 520
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1677
Practice Address - Country:US
Practice Address - Phone:812-424-8231
Practice Address - Fax:812-421-7032
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025284A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN020021455OtherRAIL ROAD MEDICARE
IL0283467070-01Medicaid
IN100242180AMedicaid
KY64348857Medicaid
IN000000082349OtherANTHEM BLUE CROSS/SHIELD
IL0283467070-01Medicaid
IN836320EMedicare PIN