Provider Demographics
NPI:1578698775
Name:KEARNEY, KEVIN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ARTHUR
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20343 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1411
Mailing Address - Country:US
Mailing Address - Phone:248-474-4846
Mailing Address - Fax:
Practice Address - Street 1:840 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2319
Practice Address - Country:US
Practice Address - Phone:313-359-7650
Practice Address - Fax:313-359-7660
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010813932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII72735Medicare UPIN