Healthcare Provider Details

I. General information

NPI: 1083206403
Provider Name (Legal Business Name): KENNEDY JAMES RINGELBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

V. Phone/Fax

Practice location:
  • Phone: 414-699-8422
  • Fax:
Mailing address:
  • Phone: 414-699-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101276267
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: