Provider Demographics
NPI:1558981001
Name:KENNINGTON, TOWNSEN G (DPM, AACFAS)
Entity type:Individual
Prefix:
First Name:TOWNSEN
Middle Name:G
Last Name:KENNINGTON
Suffix:
Gender:M
Credentials:DPM, AACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 BROADWAY STE 350
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1412
Mailing Address - Country:US
Mailing Address - Phone:260-423-2675
Mailing Address - Fax:
Practice Address - Street 1:750 BROADWAY STE 350
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1412
Practice Address - Country:US
Practice Address - Phone:260-423-2675
Practice Address - Fax:260-969-2905
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007214213ES0103X, 213ES0103X
IN07001445A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty