Healthcare Provider Details

I. General information

NPI: 1770575615
Provider Name (Legal Business Name): MICHAEL F KENNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 W MAIN ST SUITE 2
HILLSBORO OH
45133-7484
US

IV. Provider business mailing address

938 W MAIN ST SUITE 2
HILLSBORO OH
45133-7484
US

V. Phone/Fax

Practice location:
  • Phone: 937-393-4390
  • Fax: 937-393-4640
Mailing address:
  • Phone: 937-393-4390
  • Fax: 937-393-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34004486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: