Provider Demographics
NPI:1013077460
Name:KENY, MICHAEL E (DPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:KENY
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:M
Other - Last Name:KENY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPH
Mailing Address - Street 1:521 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-3219
Mailing Address - Country:US
Mailing Address - Phone:931-359-2534
Mailing Address - Fax:931-359-2569
Practice Address - Street 1:521 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-3219
Practice Address - Country:US
Practice Address - Phone:931-359-2534
Practice Address - Fax:931-359-2569
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3511622Medicaid
TN0330780003Medicare ID - Type UnspecifiedPROVIDER NUMBER