Provider Demographics
NPI:1205082211
Name:KENNALEY, ROSEMARIE ANN (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:ANN
Last Name:KENNALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4600 S MILL AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6850
Mailing Address - Country:US
Mailing Address - Phone:480-305-2888
Mailing Address - Fax:480-305-2889
Practice Address - Street 1:428 S GILBERT RD
Practice Address - Street 2:STE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2261
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-677-8283
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2014-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ23812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ357526Medicaid