Individual
WILLIAM KENNEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1400 HIGHWAY 61, MOC SOUTH, SUITE 210, FESTUS, MO 63028-4100
(636) 933-8050
(646) 933-8075
Mailing address
1400 HIGHWAY 61, MOC SOUTH, SUITE 210, FESTUS, MO 63028-4100
(636) 933-8050
(636) 933-8075
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2010002299
MO
207X00000X
Orthopaedic Surgery Physician
OS005811L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700878147
—
MO
Enumeration date
08/22/2005
Last updated
09/23/2013
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