KENNETH A BLACK

PORTAGE, IN
NPI1134184112
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: IN  01024841)
Enumeration Date2006-04-20
Last Update Date2008-02-15
Business Address
-- KENNETH A BLACK MD
3630 WILLOWCREEK RD
PORTAGE, IN 46368-5075
Phone number: 219-759-1157
Mailing Address
-- KENNETH A BLACK MD
3630 WILLOWCREEK RD
PORTAGE, IN 46368-5075
Phone number: 219-759-1157
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