Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 20441837A | IN |
NPI | 1609245042 |
---|---|
Provider Name | Michael Kenny |
First Address | Indianapolis, IN 46240-1803 |
Second Address | Indianapolis, IN 46240-1803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2015 |
Last Update Date | 16/09/2015 |