Boren, Kenneth R
Boren, Kenneth R is an sole proprietor health care provider with primary practice located at 4040 E Mclellan Rd Unit 11 , Mesa AZ 85205-3105. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Boren, Kenneth R can be contacted via phone (480) 229-2829.Contact Information
Primary practice address
4040 E Mclellan Rd Unit 11
Mesa AZ 85205-3105
Phone: (480) 229-2829
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 12288 | Arizona |
Profile Details
| NPI number | 1043205511 |
|---|---|
| LBN Legal business name | Boren, Kenneth R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 12th, 2005 |
| Last updated | Aug 11th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043205511 | NPPES |
| Arizona | MEDICAID | 226911 |
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