Provider Demographics
NPI:1881673721
Name:VAN WHY, KENT J (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:J
Last Name:VAN WHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1236 E RUSHOLME ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2473
Mailing Address - Country:US
Mailing Address - Phone:563-324-2992
Mailing Address - Fax:563-888-0499
Practice Address - Street 1:1236 E RUSHOLME ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2473
Practice Address - Country:US
Practice Address - Phone:563-324-2992
Practice Address - Fax:563-888-0499
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28991207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0109637Medicaid
IA0109637Medicaid
ILL59719Medicare PIN
IAI4501Medicare PIN