Provider Demographics
NPI:1174516306
Name:HINES, KENNETH E (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:HINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-0288
Mailing Address - Country:US
Mailing Address - Phone:502-839-6981
Mailing Address - Fax:502-839-1041
Practice Address - Street 1:504 W BROADWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1541
Practice Address - Country:US
Practice Address - Phone:502-839-6981
Practice Address - Fax:502-839-1041
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65916165Medicaid
KY65916165Medicaid
C63147Medicare UPIN