MEDICARE: RAYMOND JAMES KENNEDY III 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	2084P0800X	Psychiatry Physician	39653	MN

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	1501790	OTHER	MN	MEDICA
3	991N7KE	OTHER	MN	BCBS OF MN

General Provider Information

NPI Number	:	1871576223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND JAMES KENNEDY III MD

Provider Business Mailing Address
First Line	:	2040 WOODWINDS DR
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-2522
Country	:	US
Telephone Number	:	651-259-9750
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 WOODWINDS DR
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-2522
Country	:	US
Telephone Number	:	651-259-9750
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	01/09/2024

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