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General NPI Number Information
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NPI Number | 1871850453
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Entity Type | Organization
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Legal Business Name | KENTROMED, PLLC
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 6130 N LA CHOLLA BLVD STE 117
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City | TUCSON
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State | AZ
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Zip | 85741-3589
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Country | US
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Telephone | 520-297-1803
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Fax | 250-297-2913
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Provider Business Mailing Address
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Address Line | PO BOX 36210
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City | TUCSON
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State | AZ
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Zip | 85740-6210
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Country | US
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Telephone | 520-297-1803
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Fax | 520-297-2913
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Authorized Official
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Title or Position | OWNER
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Name | DR. TENNEY B KENTRO
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Credential | M.D.
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Telephone | 520-297-1803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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