Kenneth E Marnocha, MD
Individual provider Active NPI Diagnostic Radiology Physician · West Lafayette, IN
NPI 1699744342 · NPPES record last updated Sep 17, 2014
Key facts
- NPI
- 1699744342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 01031076A (IN)
- Practice address
- 253 Sagamore Pkwy W
West Lafayette, IN 47906-1501 - Phone
- (765) 448-8000
- NPI assigned
- Mar 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01031076A | IN | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athens Medical Group, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 01031076A | IN | Yes |
Addresses
Primary practice location
253 Sagamore Pkwy W
West Lafayette, IN 47906-1501
Mailing address
PO Box 5545
Lafayette, IN 47903-5545
Phone (765) 448-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 156682 | Other | IN | PHCS PID NUMBER |
| 10825542 | Other | IN | CAQH NUMBER |
| 000000202120 | Other | IN | ANTHEM PROVIDER NUMBER |
| 100320630 | Medicaid | IN |
Other providers in West Lafayette, IN
- Keith W. March
- Amber Kay Marion
- Monica M Markley
- Tari J Markowski
- Taylor Marlatt
- Phyllis Martin-Simmerman
- Steven C Martin
- Amanda Lee Martinez
- Kimber Joy Martinez
- Brenda Masiga-Crowell
All providers in West Lafayette, IN · Diagnostic Radiology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.