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KENNETH D PETERSEN M.D.
NPI 1922092733
Obstetrics & Gynecology in Goshen, IN

Active since September 07, 2005
1111 LIGHTHOUSE LANE, GOSHEN, IN 46526(574) 533-0348(574) 533-0277 Get Directions Write a Review

NPPES record last updated: February 4, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Kenneth D Petersen M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH D PETERSEN M.D. (NPI 1922092733) is an individual obstetrics & gynecology provider in Goshen, Indiana, licensed in Indiana (01028273) and active in the NPI registry since September 2005.

NPPES Registry Identity

NPI1922092733
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameKENNETH D PETERSENCredential: M.D.
Location Address1111 LIGHTHOUSE LANEGoshen, IN 46526-3824
Mailing Address1111 Lighthouse LaneGoshen, IN 46526-3824 · (574) 533-0348 · Fax (574) 533-0277
Phone(574) 533-0348
Fax(574) 533-0277
Sole ProprietorNo
Enumeration DateSeptember 7, 2005
Last NPPES UpdateFebruary 4, 2008
✔ NPI 1922092733 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in IN · 01028273
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
1111 LIGHTHOUSE LANE, Goshen, IN 46526
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Other Identifiers 2

Medicare ID-Type Unspecified223710C
Medicare UPINC24663

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JULIA A GAUTSCHE C.N.M.
Advanced Practice Midwife
1111 LIGHTHOUSE LANE
GOSHEN, IN 46526
Elkhart County (574) 533-0348
VERNON MAES D.O.
Obstetrics & Gynecology
1111 LIGHTHOUSE LANE
GOSHEN, IN 46526
Elkhart County (574) 533-0348
FAIRHAVEN OBSTETRICS & GYNECOLOGY, INC
Obstetrics & Gynecology
1111 LIGHTHOUSE LANE
GOSHEN, IN 46526
Elkhart County (574) 533-0348
RACHEL A JOHNS C.N.M.
Advanced Practice Midwife
1111 LIGHTHOUSE LANE
GOSHEN, IN 46526
Elkhart County (574) 533-0348
MELISSA L BACH W.H.N.P.
Nurse Practitioner
1111 LIGHTHOUSE LANE
GOSHEN, IN 46526
Elkhart County (574) 533-0348

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Petersen's NPI number?

The NPI number for Kenneth Petersen is 1922092733. It was assigned to this individual provider in the NPPES registry on September 7, 2005.

Where is Kenneth Petersen located?

Kenneth Petersen practices at 1111 Lighthouse Lane, Goshen, IN 46526. The listed phone number is (574) 533-0348.

What is Kenneth Petersen's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

When was this NPI record last updated?

The NPPES record for Kenneth Petersen was last updated on February 4, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.