Provider Demographics
NPI:1821010646
Name:KENNEY, PAUL R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:KENNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11111 SOUTH 84TH STREET
Mailing Address - Street 2:STE 2476
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4122
Mailing Address - Country:US
Mailing Address - Phone:402-339-8991
Mailing Address - Fax:402-339-6741
Practice Address - Street 1:11111 S 84TH ST
Practice Address - Street 2:STE 2476
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4122
Practice Address - Country:US
Practice Address - Phone:402-339-8991
Practice Address - Fax:402-339-6741
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE175472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA32891Medicare PIN
NE300033889Medicare PIN
NE088541Medicare PIN
E44065Medicare UPIN
IA300055728Medicare PIN
NEC50206Medicare PIN
IACJ3861Medicare PIN