Provider Demographics
NPI:1891746483
Name:KENNY, JOHN TERRANCE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TERRANCE
Last Name:KENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 766351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 1002
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-584-2029
Practice Address - Fax:502-584-0873
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042682207RC0000X
KY26475207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049366OtherANTHEM
KY2432852000OtherPASSPORT ADVANTAGE
KY1050456Medicaid
IN100344720Medicaid
KY50031703OtherPASSPORT/PASSPORT ADVTG - CTS
KY64264757Medicaid
KY060022400OtherRAILROAD MEDICARE
KY000057094POtherHUMANA - CTS
KY5921OtherSIHO - CTS
KY64264757Medicaid
KYCB1222Medicare PIN
KY000000049366OtherANTHEM
KY5921OtherSIHO - CTS
KY50031703OtherPASSPORT/PASSPORT ADVTG - CTS
IN890680FMedicare PIN