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General NPI Number Information
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NPI Number | 1386694354
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Entity Type | Individual
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Provider Name | THOMAS J KENNY IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 101 TOWER RD SUITE 120
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5007
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Country | US
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Telephone | 605-217-4320
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Fax | 605-217-2948
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Provider Business Mailing Address
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Address Line | 956 PEBBLE BEACH DR
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5107
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Country | US
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Telephone | 605-422-1080
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Fax | 605-217-2948
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 34004
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 5111
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License Number State | SD
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