MEDICARE: KENNETH MICHAEL RENNEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	H5356	TX
2	207Q00000X	Family Medicine Physician	H5356	TX
3	207QS0010X	Sports Medicine (Family Medicine) Physician	H5356	TX
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	H5356	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01186467	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8BP173	OTHER	TX	BLUE CROSS BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	610119705	OTHER	TX	US DEPT OF LABOR

General Provider Information

NPI Number	:	1437147998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH MICHAEL RENNEY MD

Provider Business Mailing Address
First Line	:	16811 SOUTHWEST FWY
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4728
Country	:	US
Telephone Number	:	281-690-4678
Fax Number	:

Provider Business Practice Location Address
First Line	:	16811 SOUTHWEST FWY
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4728
Country	:	US
Telephone Number	:	281-690-4678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/10/2017

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