Provider Demographics
NPI:1376623561
Name:MCLEOD, KENNETH DEAN SR (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DEAN
Last Name:MCLEOD
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2235
Mailing Address - Country:US
Mailing Address - Phone:251-943-1584
Mailing Address - Fax:251-943-7442
Practice Address - Street 1:1511 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2235
Practice Address - Country:US
Practice Address - Phone:251-943-1584
Practice Address - Fax:251-943-7442
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO24207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51004250OtherBCBS
406231011OtherRAILROAD MEDICARE
4314829OtherAETNA
0110393OtherMEDICARE COMPLETE
69634OtherFIRST HEALTH
0110393OtherUNITED HEALTHCARE
AL000004250Medicaid
4314829OtherAETNA