Provider Demographics
NPI:1023009347
Name:KEARNEY, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4600 INVESTMENT DR
Mailing Address - Street 2:STE 370
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6365
Mailing Address - Country:US
Mailing Address - Phone:248-267-5035
Mailing Address - Fax:248-267-5036
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:STE 370
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-267-5035
Practice Address - Fax:248-267-5036
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301036694208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1904166Medicaid
05337687341Medicare ID - Type Unspecified
MI1904166Medicaid