Provider Demographics
NPI:1336436591
Name:KENNEY-KALBUNEH, JAMIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:KENNEY-KALBUNEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1225 DERBY RD
Mailing Address - Street 2:APARTMENT 8
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5808
Mailing Address - Country:US
Mailing Address - Phone:914-799-1827
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:6G UHC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-993-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098617207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine