Kenjack Medical LLC

NPI #1528423555 in Norfolk, Virginia

Provider Information

NPI Number: 1528423555
Entity Type: Organization
Organization Name: Kenjack Medical LLC
Primary Specialty: Family Medicine
Enumeration Date: Dec 17, 2015
Last Updated: May 1, 2017

Practice Location

Address: 951 W 21ST ST
City: Norfolk
State: Virginia
ZIP Code: 23517-1534
Phone: (757) 274-4452

Authorized Official

Name: DR. GARRETT M KELLY, D.O.
Title: PRESIDENT
Phone: (757) 274-4452

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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