Provider Demographics
NPI:1720084262
Name:BALCOMBE, KENNETH LORNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LORNE
Last Name:BALCOMBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 DUTCHMANS PKWY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3372
Mailing Address - Country:US
Mailing Address - Phone:502-894-8441
Mailing Address - Fax:502-894-4453
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-894-8441
Practice Address - Fax:502-894-4453
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28985207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64289853Medicaid
INP00861077OtherMEDICARE RAILROAD- ICC
KY000000674386OtherANTHEM - NICC
KY117555OtherSIHO - NICC
IN200024650Medicaid
KY000000045106OtherBCBS
610731823OtherTAX ID
KY61-0719349OtherTAX ID
KY7100199530Medicaid
KYP00861078OtherMEDICARE RAILROAD-ICC
KY000000045106OtherBCBS
KY7100199530Medicaid
KY000000674386OtherANTHEM - NICC
KYP400024173Medicare UPIN
KY1265305Medicare ID - Type Unspecified