Healthcare Provider Details

I. General information

NPI: 1992985550
Provider Name (Legal Business Name): MICHAEL ARTHUR KENNEDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2007
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 N. CHAPEL ST, #100 PHYSICIANS GROUP, LLC
NEWARK DE
19711-2238
US

IV. Provider business mailing address

560 PEOPLES PLZ #287
NEWARK DE
19702-4798
US

V. Phone/Fax

Practice location:
  • Phone: 302-737-6099
  • Fax: 302-737-6299
Mailing address:
  • Phone: 302-388-4424
  • Fax: 302-834-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD059935-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: