Healthcare Provider Details

I. General information

NPI: 1255311361
Provider Name (Legal Business Name): KENNETH JAMES MCCANN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 PLEASANT ST SUITE 303
DES MOINES IA
50309-1416
US

IV. Provider business mailing address

1215 PLEASANT ST SUITE 303
DES MOINES IA
50309-1416
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-4311
  • Fax: 515-241-4320
Mailing address:
  • Phone: 515-241-4311
  • Fax: 515-241-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO00617
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3772
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: