MEDICARE: KENNEDY MEDICAL SERVICE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1003975442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEDY MEDICAL SERVICE CORP

Provider Business Mailing Address
First Line	:	175 E DELAWARE PL
Second Line	:	SUITE 5024
City	:	CHICAGO
State	:	IL
Zip	:	60611-1756
Country	:	US
Telephone Number	:	312-504-0438
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 E DELAWARE PL
Second Line	:	SUITE 5024
City	:	CHICAGO
State	:	IL
Zip	:	60611-1756
Country	:	US
Telephone Number	:	312-504-0438
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LOFTON KENNEDY JR.
Credential	:	M.D.
Telephone Number	:	312-504-0438

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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Directions to “KENNEDY MEDICAL SERVICE CORP ” Practice Location

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