MEDICARE: RICHARD D KENNEDY MD

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	35.089392	OH
2	207Q00000X	Family Medicine Physician	35.089392	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578689493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD D KENNEDY MD

Provider Business Mailing Address
First Line	:	96 INTEGRITY DR STE H
Second Line	:
City	:	HEBRON
State	:	OH
Zip	:	43025-7013
Country	:	US
Telephone Number	:	220-564-2100
Fax Number	:	220-564-2101

Provider Business Practice Location Address
First Line	:	96 INTEGRITY DR STE H
Second Line	:
City	:	HEBRON
State	:	OH
Zip	:	43025-7013
Country	:	US
Telephone Number	:	220-564-2100
Fax Number	:	220-564-2101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	05/11/2018

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Directions to “ RICHARD D KENNEDY MD” Practice Location

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