Provider Demographics
NPI:1760483762
Name:KEARNEY, TERRANCE P (DO)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:P
Last Name:KEARNEY
Suffix:
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 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-4533
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:1500 W ICE LAKE RD
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-8509
Practice Address - Country:US
Practice Address - Phone:906-265-5378
Practice Address - Fax:906-265-6332
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080036031OtherRAILROAD MEDICARE
WI30068700Medicaid
MI3257527Medicaid
WI30068700Medicaid
MI0M67210001Medicare PIN