Basic Information
| Provider Information | |||||||||
| NPI: | 1679531339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKENNEY | ||||||||
| FirstName: | KIMBERLEY | ||||||||
| MiddleName: | LENTZ | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LENTZ | ||||||||
| OtherFirstName: | KIMBERLEY | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 19510 | ||||||||
| Address2: | FLORIDA UNITED RADIOLOGY | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333180510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004372672 | ||||||||
| FaxNumber: | 9548511758 | ||||||||
| Practice Location | |||||||||
| Address1: | 20900 BISCAYNE BOULEVARD | ||||||||
| Address2: | AVENTURA HOSPITAL | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056827398 | ||||||||
| FaxNumber: | 3059376988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 11/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME61583 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 375398100 | 05 | FL | MEDICAID |