Basic Information
| Provider Information | |||||||||
| NPI: | 1396742193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILK | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 DUTCHMANS PKWY | ||||||||
| Address2: | #380 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028948441 | ||||||||
| FaxNumber: | 5028944453 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 DUTCHMANS PKWY | ||||||||
| Address2: | #380 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028948441 | ||||||||
| FaxNumber: | 5028944453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 17604 | KY | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 01023705A | IN | N | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0000000454443 | 01 | KY | ANTHEM FACET | OTHER | 64176043 | 05 | KY | MEDICAID | 040006458 | 01 | KY | RAILROAD MEDICARE | OTHER | 200065780A | 05 | IN | MEDICAID |