Provider Demographics
NPI:1215913868
Name:YENAL, KEM (MD)
Entity type:Individual
Prefix:
First Name:KEM
Middle Name:
Last Name:YENAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-425-2424
Mailing Address - Fax:215-425-0342
Practice Address - Street 1:1741 FRANKFORD AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19125-2445
Practice Address - Country:US
Practice Address - Phone:215-425-2424
Practice Address - Fax:215-425-0342
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2013-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD051919L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA450479OtherCOVENTRY HEALTH AMERICA
PAP00083356OtherRAIL ROAD MEDICARE
PA30011521OtherKEYSTONE MERCY HEALTH
PA3041266OtherAETNA HMO
PA4602164OtherAEETNA PPO
PA0842407000OtherINDEPENDENCE BLUE CROSS
PA001540483Medicaid
PA15271OtherBRAVO HEALTH
PA809776OtherHIGHMARK BLUE SHIELD
PA3Y7137OtherHEALTH NET
PAP00159973OtherRAILROAD MEDICARE
PA809776Medicare PIN
PA450479OtherCOVENTRY HEALTH AMERICA