MEDICARE: ELIZABETH ANN KENNARD M D

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	207VE0102X	Reproductive Endocrinology Physician	35056422K	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

General Provider Information

NPI Number	:	1811986987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN KENNARD M D

Provider Business Mailing Address
First Line	:	4830 KNIGHTSBRIDGE BLVD
Second Line	:	SUITE E
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2300
Country	:	US
Telephone Number	:	614-451-2280
Fax Number	:	614-451-4352

Provider Business Practice Location Address
First Line	:	4830 KNIGHTSBRIDGE BLVD
Second Line	:	SUITE E
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2300
Country	:	US
Telephone Number	:	614-451-2280
Fax Number	:	614-451-4352

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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