Healthcare Provider Details

I. General information

NPI: 1104044114
Provider Name (Legal Business Name): HAROLD LLOYD KENNEDY MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD. 1031 B MIDWEST CARDIOVASCULAR
SAINT LOUIS MO
63132
US

IV. Provider business mailing address

5 APPLE TREE LN
SAINT LOUIS MO
63124-1601
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-5650
  • Fax:
Mailing address:
  • Phone: 314-993-4408
  • Fax: 314-993-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD 29940
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD 29940
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: