Healthcare Provider Details

I. General information

NPI: 1306824842
Provider Name (Legal Business Name): ROBERT KENYON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MOUNT CARMEL MALL SUITE 300
COLUMBUS OH
43222-1553
US

IV. Provider business mailing address

PO BOX 713189
COLUMBUS OH
43271-3189
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-6420
  • Fax: 614-224-6423
Mailing address:
  • Phone: 440-777-6017
  • Fax: 440-777-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-085020
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: