Provider Demographics
NPI:1891437257
Name:KENNETT HEART AND VASCULAR PLLC
Entity Type:Organization
Organization Name:KENNETT HEART AND VASCULAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHSIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALHADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-423-8200
Mailing Address - Street 1:327 SUMMAR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3930
Mailing Address - Country:US
Mailing Address - Phone:731-423-8200
Mailing Address - Fax:
Practice Address - Street 1:304 TEACO RD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3266
Practice Address - Country:US
Practice Address - Phone:731-423-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty