Provider Demographics
NPI:1205061389
Name:HILBISH, KENTON SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:KENTON
Middle Name:SHAWN
Last Name:HILBISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0485
Mailing Address - Country:US
Mailing Address - Phone:765-529-0780
Mailing Address - Fax:765-521-9891
Practice Address - Street 1:152 WITTENBRAKER AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-5000
Practice Address - Country:US
Practice Address - Phone:765-599-3100
Practice Address - Fax:765-518-5365
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071106208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201069150Medicaid
IN201069150Medicaid
INM400073421Medicare PIN