Individual
KENNETH MICHAEL RENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16811 SOUTHWEST FWY, SUGAR LAND, TX 77479-4728
(281) 690-4678
Mailing address
16811 SOUTHWEST FWY, SUGAR LAND, TX 77479-4728
(281) 690-4678
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
H5356
TX
207Q00000X
Family Medicine Physician
H5356
TX
207QS0010X
Sports Medicine (Family Medicine) Physician
H5356
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
H5356
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122686202
—
TX
05
—
122686205
—
TX
05
—
122686206
—
TX
05
—
122686207
—
TX
05
—
122686208
—
TX
05
—
122686209
—
TX
05
—
122686210
—
TX
01
—
610119705
US DEPT OF LABOR
TX
01
—
8BP173
BLUE CROSS BLUE SHIELD
TX
01
—
P01186467
RR MEDICARE
TX
Enumeration date
10/10/2005
Last updated
08/10/2017
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