Healthcare Provider Details

I. General information

NPI: 1750341459
Provider Name (Legal Business Name): BRIAN JAMES KENNEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W KING ST STE M
OWOSSO MI
48867-2100
US

IV. Provider business mailing address

802 W KING ST STE M
OWOSSO MI
48867-2100
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4100
  • Fax: 989-729-4066
Mailing address:
  • Phone: 989-729-4100
  • Fax: 989-729-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301405919
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301405919
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: