Provider Demographics
NPI:1407835598
Name:TEWEL, KENNETH M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:TEWEL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:2901 S MCINTYRE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4209
Practice Address - Country:US
Practice Address - Phone:812-332-3062
Practice Address - Fax:812-332-3062
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2014-07-01
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Provider Licenses
StateLicense IDTaxonomies
IN01022362207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100373260Medicaid
IN100373260Medicaid
INB46679Medicare UPIN
ININ1943003Medicare PIN
ININ1942003Medicare PIN