Individual
DR. THOMAS J KENNY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 TOWER RD, SUITE 120, DAKOTA DUNES, SD 57049-5007
(605) 217-4320
(605) 217-2948
Mailing address
956 PEBBLE BEACH DR, DAKOTA DUNES, SD 57049-5107
(605) 422-1080
(605) 217-2948
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
34004
IA
207Y00000X
Otolaryngology Physician
Primary
5111
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100251553 00
—
NE
05
—
10025206800
—
NE
05
—
1239616
—
IA
05
—
2239616
—
IA
01
—
37196
BLUE CROSS PROVIDER NUM
IA
01
—
37777
2ND BCBS PROVIDER NUM
IA
05
—
7701502
—
SD
05
—
7701503
—
SD
Enumeration date
05/11/2006
Last updated
06/15/2012
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