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General NPI Number Information
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NPI Number | 1467988451
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Entity Type | Individual
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Provider Name | MICHAEL KENNY PA
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 12150 30 MILE RD
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City | WASHINGTON TOWNSHIP
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State | MI
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Zip | 48095-2035
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Country | US
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Telephone | 586-336-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 12150 30 MILE RD
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City | WASHINGTON TOWNSHIP
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State | MI
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Zip | 48095-2035
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601008191
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License Number State | MI
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