1912038597 NPI number — BENNY SP KO M.D.

Table of content: (NPI 1851260764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912038597 NPI number — BENNY SP KO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KO
Provider First Name:
BENNY
Provider Middle Name:
SP
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912038597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637999
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-7999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-682-2030
Provider Business Mailing Address Fax Number:
317-644-5060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3660 GUION RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46222-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-920-7139
Provider Business Practice Location Address Fax Number:
317-920-7229
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  01024080A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00960535 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000703094 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100381260A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com