Provider Demographics
NPI:1396742193
Name:SILK, KENNETH LYNN (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LYNN
Last Name:SILK
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:#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:#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:2005-07-07
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17604207Y00000X
IN01023705A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000454443OtherANTHEM FACET
KY64176043Medicaid
KY040006458OtherRAILROAD MEDICARE
IN200065780AMedicaid
C73563Medicare UPIN
KY1276002Medicare ID - Type Unspecified
IN195900BMedicare ID - Type Unspecified