Provider Demographics
NPI:1457398570
Name:KENNAR, JEAN M (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:KENNAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3920 BEE RIDGE RD
Mailing Address - Street 2:STE E BLDG E
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-923-1861
Mailing Address - Fax:941-927-8491
Practice Address - Street 1:3920 BEE RIDGE RD BLDG E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-923-1861
Practice Address - Fax:941-927-8491
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 44849208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2531708OtherCIGNA
FL313414OtherAVMED
FL000761050002OtherUNITED HEALTHCARE
FL58438OtherBCBS
FLP00036360OtherRAILROAD MEDICARE
FL3275651OtherAETNA
FLP00036360OtherRAILROAD MEDICARE
FL3275651OtherAETNA