Provider Demographics
NPI:1922072339
Name:KIDD, GENA R (MD)
Entity Type:Individual
Prefix:DR
First Name:GENA
Middle Name:R
Last Name:KIDD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1400 TEAL RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2463
Mailing Address - Country:US
Mailing Address - Phone:765-477-2020
Mailing Address - Fax:765-477-8200
Practice Address - Street 1:1400 TEAL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2463
Practice Address - Country:US
Practice Address - Phone:765-477-2020
Practice Address - Fax:765-477-8200
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2018-05-02
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Provider Licenses
StateLicense IDTaxonomies
IN01054602A207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200349180Medicaid
G77227Medicare UPIN