Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01033784 | IN |
NPI | 1013021385 |
---|---|
Provider Name | Joseph Kenny |
First Address | Chicago, IL 60686-0001 |
Second Address | Franklin, IN 46131-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E96783 | (02) |