Healthcare Provider Details

I. General information

NPI: 1871850453
Provider Name (Legal Business Name): KENTROMED, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 N LA CHOLLA BLVD STE 117
TUCSON AZ
85741-3589
US

IV. Provider business mailing address

PO BOX 36210
TUCSON AZ
85740-6210
US

V. Phone/Fax

Practice location:
  • Phone: 520-297-1803
  • Fax: 250-297-2913
Mailing address:
  • Phone: 520-297-1803
  • Fax: 520-297-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TENNEY B KENTRO
Title or Position: OWNER
Credential: M.D.
Phone: 520-297-1803