Healthcare Provider Details

I. General information

NPI: 1659348498
Provider Name (Legal Business Name): KEVIN D. BRENIMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LILE CT SUITE 200
LITTLE ROCK AR
72205-6242
US

IV. Provider business mailing address

1 LILE CT SUITE 200
LITTLE ROCK AR
72205-6242
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-5500
  • Fax: 501-224-1166
Mailing address:
  • Phone: 501-224-5500
  • Fax: 501-224-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License NumberE4508
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberE4508
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: