Provider Demographics
NPI:1316960073
Name:SANN, KENNETH IRA (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:IRA
Last Name:SANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-4508
Mailing Address - Country:US
Mailing Address - Phone:413-663-5547
Mailing Address - Fax:413-664-1057
Practice Address - Street 1:38 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-4508
Practice Address - Country:US
Practice Address - Phone:413-663-5547
Practice Address - Fax:413-664-1057
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1428213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0317381Medicaid
MA0317381Medicaid