Provider Demographics
NPI:1992753172
Name:SCRIBNER, KENNETH W (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:SCRIBNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:241 W WEAVER RD
Mailing Address - Street 2:#190
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-9799
Mailing Address - Country:US
Mailing Address - Phone:217-876-5240
Mailing Address - Fax:217-876-5245
Practice Address - Street 1:241 W WEAVER RD
Practice Address - Street 2:#190
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-9799
Practice Address - Country:US
Practice Address - Phone:217-876-5240
Practice Address - Fax:217-876-5245
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-074311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005800282OtherBCBS
IL036074311Medicaid
IL0005800282OtherBCBS
IL783020Medicare ID - Type Unspecified