Provider Demographics
NPI:1235234675
Name:RENKENS, KENNETH L JR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:RENKENS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-228-7000
Mailing Address - Fax:317-228-2321
Practice Address - Street 1:13225 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5480
Practice Address - Country:US
Practice Address - Phone:317-228-7000
Practice Address - Fax:317-228-2321
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037463A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000011598OtherM-PLAN PROVIDER NUMBER
IN000000214072OtherANTHEM PROVIDER NUMBER
IN0569464OtherCIGNA
IN366735000OtherUS DEPT. OF LABOR
IN366735000OtherUS POSTAL SERVICE WORKERS
IN000000214072OtherUNICARE PROVIDER NUMBER
IN140007814OtherMEDICARE RAILROAD
IN366735000OtherUS POSTAL SERVICE WORKERS
IN000000214072OtherANTHEM PROVIDER NUMBER