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NPI Code Detail

MEDICARE: DR. GARDNER THOMAS KENNY M.D.

MEDICARE: DR. GARDNER THOMAS KENNY M.D.
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
1207L00000XAnesthesiology Physician036086011IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1214881OTHERILMULTISPECIALTY GROUP PTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851383947
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARDNER THOMAS KENNY M.D.
Provider Business Mailing Address
First Line : PO BOX 3988
Second Line :
City : CARBONDALE
State : IL
Zip : 62902-3988
Country : US
Telephone Number : 618-457-5200
Fax Number :
Provider Business Practice Location Address
First Line : 405 W JACKSON ST
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1462
Country : US
Telephone Number : 618-549-0721
Fax Number : 618-529-0449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 12/02/2021

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