Provider Demographics
NPI:1871850453
Name:KENTROMED, PLLC
Entity Type:Organization
Organization Name:KENTROMED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TENNEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KENTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-297-1803
Mailing Address - Street 1:PO BOX 36210
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6210
Mailing Address - Country:US
Mailing Address - Phone:520-297-1803
Mailing Address - Fax:520-297-2913
Practice Address - Street 1:6130 N LA CHOLLA BLVD STE 117
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3589
Practice Address - Country:US
Practice Address - Phone:520-297-1803
Practice Address - Fax:250-297-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty