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NPI Code Detail

MEDICARE: TERRANCE P KEARNEY DO

MEDICARE: TERRANCE P KEARNEY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician5101012079MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080036031OTHERMIRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760483762
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRANCE P KEARNEY DO
Provider Business Mailing Address
First Line : 4602 DEPT
Second Line :
City : CAROL STREAM
State : IL
Zip : 60122-0021
Country : US
Telephone Number : 906-225-4533
Fax Number : 906-225-4537
Provider Business Practice Location Address
First Line : 1500 W ICE LAKE RD
Second Line :
City : IRON RIVER
State : MI
Zip : 49935-8509
Country : US
Telephone Number : 906-265-5378
Fax Number : 906-265-6332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 04/21/2009

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Directions to “ TERRANCE P KEARNEY DO” Practice Location

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