Provider Demographics
NPI:1952401697
Name:MUSANA, KENNETH APOLLO (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:APOLLO
Last Name:MUSANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 SOUTH GOVERNORS AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4111
Mailing Address - Country:US
Mailing Address - Phone:302-678-5008
Mailing Address - Fax:302-678-5505
Practice Address - Street 1:121 NATIONWIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-384-1862
Practice Address - Fax:434-384-7704
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44975207R00000X
VA0101243775207R00000X, 207RG0100X
DEC10025179207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34589400Medicaid
WI34589400Medicaid
WI086772200Medicare ID - Type Unspecified