Provider Demographics
NPI:1568462422
Name:LOVKO, KENNETH L (PHD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:LOVKO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 PRO-MED LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5323
Mailing Address - Country:US
Mailing Address - Phone:317-587-0567
Mailing Address - Fax:317-574-1230
Practice Address - Street 1:2506 WILLOWBROOK PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1564
Practice Address - Country:US
Practice Address - Phone:317-587-0567
Practice Address - Fax:317-574-1230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040534A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN317200EMedicare ID - Type Unspecified