MEDICARE: WILLIAM KENNEN JR. DO

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	207X00000X	Orthopaedic Surgery Physician	2010002299	MO
2	207X00000X	Orthopaedic Surgery Physician	OS005811L	PA

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

General Provider Information

NPI Number	:	1700878147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM KENNEN JR. DO

Provider Business Mailing Address
First Line	:	1400 HIGHWAY 61
Second Line	:	MOC SOUTH, SUITE 210
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-933-8050
Fax Number	:	636-933-8075

Provider Business Practice Location Address
First Line	:	1400 HIGHWAY 61
Second Line	:	MOC SOUTH, SUITE 210
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-933-8050
Fax Number	:	646-933-8075

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	09/23/2013

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Directions to “ WILLIAM KENNEN JR. DO” Practice Location

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