Provider Demographics
NPI:1437147998
Name:RENNEY, KENNETH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
Last Name:RENNEY
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 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4728
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5356207P00000X, 207Q00000X, 207QS0010X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122686202Medicaid
TX122686207Medicaid
TX122686210Medicaid
TXP01186467OtherRR MEDICARE
TX8BP173OtherBLUE CROSS BLUE SHIELD
TX122686205Medicaid
TX122686206Medicaid
TX122686208Medicaid
TX122686209Medicaid
TX610119705OtherUS DEPT OF LABOR
TX8J1685Medicare PIN
TXTXB151331Medicare PIN
TX501679ZSVEMedicare PIN
TX122686205Medicaid
TX122686207Medicaid
TX8F9762Medicare PIN
TX122686210Medicaid
TX501679ZSWDMedicare PIN