Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kenneth D Petersen, MD

Individual provider Obstetrics & Gynecology Physician · NPI 1922092733

Kenneth D Petersen, MD is an Obstetrics & Gynecology Physician in Goshen, Indiana. Licensed in Indiana. Registered with an NPI since 2005.

Licensed in
IN
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1111 Lighthouse Ln
Goshen, IN 46526-3824
Phone: (574) 533-0348
Fax: (574) 533-0277
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Obstetrics & Gynecology Physician (primary) Taxonomy 207V00000X · Licence 01028273 (IN)

Record details

NPI number1922092733
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedSeptember 7, 2005
Last updated in NPPESFebruary 4, 2008
Mailing address1111 Lighthouse Lane, Goshen, IN 46526-3824

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