Healthcare Provider Details

I. General information

NPI: 1760483762
Provider Name (Legal Business Name): TERRANCE P KEARNEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W ICE LAKE RD
IRON RIVER MI
49935-8509
US

IV. Provider business mailing address

4602 DEPT
CAROL STREAM IL
60122-0021
US

V. Phone/Fax

Practice location:
  • Phone: 906-265-5378
  • Fax: 906-265-6332
Mailing address:
  • Phone: 906-225-4533
  • Fax: 906-225-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101012079
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: