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General NPI Number Information
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NPI Number | 1174889158
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Entity Type | Individual
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Provider Name | COLIN MATTHEW KENNY DO
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Gender | Male
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 36475 FIVE MILE RD ST. MARY MERCY HOSPITAL
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City | LIVONIA
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State | MI
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Zip | 48154
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Country | US
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Telephone | 515-203-5731
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Fax |
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Provider Business Mailing Address
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Address Line | 210 OLEANDER AVE
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City | CORPUS CHRISTI
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State | TX
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Zip | 78404-1731
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Country | US
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Telephone | 515-203-5731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | Q5004
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License Number State | TX
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