Provider Demographics
NPI:1790881597
Name:JEAN M KENNAR MD PA
Entity Type:Organization
Organization Name:JEAN M KENNAR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENNAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:941-923-1861
Mailing Address - Street 1:3920 BEE RIDGE RD
Mailing Address - Street 2:STE E BLDG E
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-923-1861
Mailing Address - Fax:941-927-8491
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:STE E BLDG E
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233
Practice Address - Country:US
Practice Address - Phone:941-923-1861
Practice Address - Fax:941-927-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44849208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58438AMedicare ID - Type Unspecified
D56969Medicare UPIN