Provider Demographics
NPI:1609835354
Name:DOOLITTLE, KENNETH HERBERT II (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HERBERT
Last Name:DOOLITTLE
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:MOUNT VERNON
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1440
Mailing Address - Country:US
Mailing Address - Phone:740-393-2226
Mailing Address - Fax:740-393-2220
Practice Address - Street 1:1375 YAUGER RD
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-393-2226
Practice Address - Fax:740-393-2220
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35053777207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0633916Medicaid
F24919Medicare UPIN
OH0633916Medicaid