Provider Demographics
NPI:1376629600
Name:TENNY, ROBERT T (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:TENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11912 MOHAWK LN
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1039
Mailing Address - Country:US
Mailing Address - Phone:816-520-0323
Mailing Address - Fax:
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 432
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-560-0555
Practice Address - Fax:816-268-4740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR2B652083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50417Medicare UPIN