Individual
MATTHEW P KENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
728 W WACKERLY ST STE 100, MIDLAND, MI 48640-4724
(989) 839-8824
(989) 835-3398
Mailing address
4000 WELLNESS DR, MIDLAND, MI 48670-2000
(844) 832-1956
(989) 633-5241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004770
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E66019098
MEDICARE PTAN
MI
01
—
Z96017107
MEDICARE PTAN
MI
Enumeration date
07/24/2006
Last updated
10/25/2025
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