Provider Demographics
NPI:1679531339
Name:MCKENNEY, KIMBERLEY LENTZ (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:LENTZ
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:ANNE
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 19510
Mailing Address - Street 2:FLORIDA UNITED RADIOLOGY
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33318-0510
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:954-851-1758
Practice Address - Street 1:20900 BISCAYNE BOULEVARD
Practice Address - Street 2:AVENTURA HOSPITAL
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-682-7398
Practice Address - Fax:305-937-6988
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME615832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375398100Medicaid
FL375398100Medicaid
FL25307Medicare ID - Type Unspecified