Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036-138085 | IL |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 036-138085 | IL |
NPI | 1154565307 |
---|---|
Provider Name | Dr. Ryan Michael Kenny |
First Address | Sycamore, IL 60178-3125 |
Second Address | Sycamore, IL 60178-3125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2009 |
Last Update Date | 01/12/2020 |