Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Kellen Thomas Bannon

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1649535279

Dr. Kellen Thomas Bannon is an Emergency Medicine in Toledo, Ohio. Graduated from West Virginia School of Osteopathic Medicine in 2012, 14 years ago. Practices with Southeastern Emergency Physicians LLC, a 786-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
14
Trained at
West Virginia School of Osteopathic Medicine
Licensed in
TN
In the registry since
2012
Specialties on file
2
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Practice location Address checks out

2213 Cherry St
Toledo, OH 43608-2603
Phone: (419) 251-4724
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 2855 (TN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1649535279
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 10, 2012
Last updated in NPPESOctober 25, 2023
Certification dateOctober 25, 2023
Mailing address1901 Clinch Ave, Knoxville, TN 37916-2307

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolWEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE
Graduated 2012 (14 years in practice)
Group practice Southeastern Emergency Physicians Llc — 786 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Toledo