KENNETH D PETERSEN (NPI# 1922092733) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922092733 |
| Entity Type | Individual |
| Full Name | KENNETH D PETERSEN |
| Credential | M.D. |
| Practice Address |
1111 Lighthouse Lane Goshen IN 46526-3824 |
| Practice Telephone | 5745330348 |
| Practice Fax Number | 5745330277 |
| Mailing Telephone | 5745330348 |
| Mailing Fax Number | 5745330277 |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2008-02-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 01028273 | IN | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578129763 | Kenneth Ryan Petersen | Physical Therapist | 754 N College Rd Ste D, Twin Falls, ID 83301-5822 | 2019-05-14 |
| 1972879401 | Kenneth R Petersen | Pharmacist | 5500 Martin Way E, Lacey, WA 98516-6326 | 2012-03-29 |
| 1568637395 | Kenneth Wendell Petersen | Orthopaedic Surgery | 2820 E Rock Haven Rd, Suite # 120, Harrisonville, MO 64701-4411 | 2008-04-23 |
| 1912017104 | Kenneth R. Petersen | Internal Medicine | 7702 N Alpine Rd, Loves Park, IL 61111-3107 | 2006-08-30 |
| Street Address |
1111 LIGHTHOUSE LANE |
| City | GOSHEN |
| State | IN |
| Zip Code | 46526-3824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073722179 | Anthereca E Lane | Obstetrics & Gynecology | 1111 Lighthouse Lane, Goshen, IN 46526-3824 | 2007-05-22 |
| 1437183605 | Fairhaven Obstetrics & Gynecology, Inc | Nurse Practitioner | 1111 Lighthouse Lane, Goshen, IN 46526-3824 | 2006-07-11 |
| 1407840952 | Fred A Simon Jr. | Obstetrics & Gynecology | 1111 Lighthouse Lane, Goshen, IN 46526-3824 | 2005-09-09 |
| 1003800814 | Julia A Gautsche | Advanced Practice Midwife | 1111 Lighthouse Lane, Goshen, IN 46526-3824 | 2005-09-07 |
| 1720072531 | Melissa L Bach | Nurse Practitioner | 1111 Lighthouse Lane, Goshen, IN 46526-3824 | 2005-09-07 |
| 1548254352 | Rachel A Johns | Advanced Practice Midwife | 1111 Lighthouse Lane, Goshen, IN 46526-3824 | 2005-09-07 |
| 1366436172 | Vernon L Maes | Obstetrics & Gynecology | 1111 Lighthouse Lane, Goshen, IN 46526-3824 | 2005-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134631344 | Heidi Kauffmann | Social Worker | 2606 Peddler's Village Rd. Suite 210, Goshen, IN 46526 | 2017-10-27 |
| 1952812034 | Blue Diamond Villas | Skilled Nursing Facility | 1510 Sandpiper Lane, Goshen, IN 46526 | 2017-10-17 |
| 1578086534 | Anthony Escotto | Physical Therapist | 223 North Chicago Avenue, Goshen, IN 46526 | 2017-07-21 |
| 1831544774 | April Noelle Hart | Registered Nurse | 2606 Peddlers Village Rd., Suite 215, Goshen, IN 46526 | 2016-04-28 |
| 1639530108 | Amanda Miller | Physical Therapy Assistant | 114 Watertower Court, Goshen, IN 46526 | 2016-03-11 |
| 1720486095 | Gloria White | Pharmacist | 4430 Elkhart Road, C/o Walgreens, Goshen, IN 46526 | 2014-12-18 |
| 1184982472 | Dianna Christine Hoover | Occupational Therapist | 1627 Autumn Blaze Lane, Goshen, IN 46526 | 2012-04-24 |
| 1629361357 | Amy Rebecca Pointon | Nurse Practitioner | 1615 Winsted Dr Ste 1, Goshen, IN 46526 | 2011-05-27 |
| 1659670685 | Michiana Eye Center LLC | Optometrist | 1747 Stafford Ct, Goshen, IN 46526 | 2011-03-16 |
| 1467759001 | Natasha Candace Pontius | Occupational Therapy Assistant | 2400 College Aveune, Goshen, IN 46526 | 2011-02-17 |
| Find all providers in zip 46526 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568729754 | Hee M Park | Obstetrics & Gynecology | 9 Lake View Dr, Goshen, NY 10924-5800 | 2012-04-12 |
| 1902836893 | Katherine Amelia Overton | Obstetrics & Gynecology | 31180 Road 72, Goshen, CA 93227-9997 | 2006-07-04 |
| 1851385660 | James R Vancuren | Obstetrics & Gynecology | 1122 Professional Dr, Goshen, IN 46526-3819 | 2005-09-07 |
| 1942754353 | Rebecca Gindelberger | Obstetrics & Gynecology | 1122 Professional Dr, Goshen, IN 46526-3819 | 2016-08-15 |
| 1720491947 | Ashley Scott | Obstetrics & Gynecology | 1122 Professional Dr, Goshen, IN 46526 | 2014-06-05 |
| 1699057976 | Rocio Ahuja | Obstetrics & Gynecology | 1111 Lighthouse Ln, Goshen, IN 46526-3824 | 2011-09-13 |
| 1497053599 | Ellen Elizabeth Cuddeback | Obstetrics & Gynecology | 1122 Professional Dr, Goshen, IN 46526-3819 | 2011-03-14 |
| 1083857023 | James Nnuro Frimpong | Obstetrics & Gynecology | 1122 Professional Dr, Goshen, IN 46526-3819 | 2009-04-07 |
| 1073722179 | Anthereca E Lane | Obstetrics & Gynecology | 1111 Lighthouse Lane, Goshen, IN 46526-3824 | 2007-05-22 |
| 1467474809 | Gregory L Todd | Obstetrics & Gynecology | 1111 Lighthouse Ln, Goshen, IN 46526-3824 | 2006-07-24 |
| Find all providers in GOSHEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.