Provider Demographics
NPI:1053305086
Name:CHEYNE, KEN L (MD)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:L
Last Name:CHEYNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1453
Mailing Address - Country:US
Mailing Address - Phone:515-241-8336
Mailing Address - Fax:515-241-6465
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:SUITE 406
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1453
Practice Address - Country:US
Practice Address - Phone:515-241-8336
Practice Address - Fax:515-241-6465
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2011-11-19
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Provider Licenses
StateLicense IDTaxonomies
IA238732080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1053305086Medicaid
IA1053305086Medicaid
53506OtherMEDICARE
53506OtherMEDICARE