Healthcare Provider Details

I. General information

NPI: 1225483571
Provider Name (Legal Business Name): KEVIN HENNENHOEFER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107 SOUTHPARK DRIVE SUITE 204
DURHAM NC
27713
US

IV. Provider business mailing address

5107 SOUTHPARK DRIVE SUITE 204
DURHAM NC
27713
US

V. Phone/Fax

Practice location:
  • Phone: 919-706-1806
  • Fax: 919-300-5182
Mailing address:
  • Phone: 919-706-1806
  • Fax: 919-300-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberWV EDU
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: