Basic Information
| Provider Information | |||||||||
| NPI: | 1003994310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHIKLER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 909 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402010909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026297702 | ||||||||
| FaxNumber: | 5026293975 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 E GRAY ST | ||||||||
| Address2: | STE 1000 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026297702 | ||||||||
| FaxNumber: | 5026293975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 16806 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0216X | 16806 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 100002050 | 05 | IN | MEDICAID | 64168065 | 05 | KY | MEDICAID |