Michael Kennis, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

13784 Issued in ND

Practice address

5300 Harroun Rd
Suite 304
Sylvania, OH 43560-2182

Phone

(419) 824-1100

Fax

(419) 824-1771

NPI assigned

Jun 27, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1215291083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 HARROUN RD",
            "address_2": "SUITE 304",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602182",
            "telephone_number": "419-824-1100",
            "fax_number": "419-824-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 HARROUN RD",
            "address_2": "SUITE 304",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602182",
            "telephone_number": "419-824-1100",
            "fax_number": "419-824-1771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNIS",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-27",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ND",
            "license": "13784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corinne Keller, M.A.,CCC-SLP
• Rachel Kellett
• Rose Kemmerling, MS, GC, MPH
• Tonia Tequila Kemp
• Chasity Ann Kendall, CRNP
• Nabeel Khan, M.D.
• Resha Khanal, MD
• Jennifer Kidman
• Eric Paul Kielhorn, M.D.
• Heather Marie King, LPC

• Student in an Organized Health Care Education/Training Program in Sylvania, OH
• Providers in Sylvania, OH by specialty
• Student in an Organized Health Care Education/Training Program in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.