Provider Demographics
NPI:1164721338
Name:KENNY, MCCABE CLAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MCCABE
Middle Name:CLAYTON
Last Name:KENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12129 UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8298
Mailing Address - Country:US
Mailing Address - Phone:515-400-3550
Mailing Address - Fax:
Practice Address - Street 1:12129 UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8298
Practice Address - Country:US
Practice Address - Phone:515-400-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0062739208800000X
390200000X
IAMD-44151208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program