Provider Demographics
NPI:1285338178
Name:KENNEY, SARA (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:965 WILSON RD STE A110
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-6410
Mailing Address - Country:US
Mailing Address - Phone:517-353-1730
Mailing Address - Fax:517-355-0342
Practice Address - Street 1:15 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2508
Practice Address - Country:US
Practice Address - Phone:616-233-1678
Practice Address - Fax:616-234-2625
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIK500758585608261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health