Provider Demographics
NPI:1942261243
Name:MANKOWSKI, KENNETH ALAN (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALAN
Last Name:MANKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5762 N HAMILTON ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1326
Mailing Address - Country:US
Mailing Address - Phone:614-961-4620
Mailing Address - Fax:614-961-4569
Practice Address - Street 1:5762 N HAMILTON ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1326
Practice Address - Country:US
Practice Address - Phone:614-961-4620
Practice Address - Fax:614-961-4569
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007527M2084N0400X
MI51010126532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H28499Medicare UPIN
4037423Medicare ID - Type Unspecified