Provider Demographics
NPI:1841208196
Name:KEMENNU, LUCIA A (MD)
Entity Type:Individual
Prefix:MISS
First Name:LUCIA
Middle Name:A
Last Name:KEMENNU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27555 FARMINGTON RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3376
Mailing Address - Country:US
Mailing Address - Phone:248-477-5608
Mailing Address - Fax:248-427-0010
Practice Address - Street 1:27555 FARMINGTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3376
Practice Address - Country:US
Practice Address - Phone:248-477-5608
Practice Address - Fax:248-427-0010
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051164207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00857637OtherRAILROAD MEDICARE
MI3053204Medicaid
E92706Medicare UPIN
MIM11340007Medicare PIN
MI3053204Medicaid