Healthcare Provider Details

I. General information

NPI: 1578689493
Provider Name (Legal Business Name): RICHARD D KENNEDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 INTEGRITY DR STE H
HEBRON OH
43025-7013
US

IV. Provider business mailing address

96 INTEGRITY DR STE H
HEBRON OH
43025-7013
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-2100
  • Fax: 220-564-2101
Mailing address:
  • Phone: 220-564-2100
  • Fax: 220-564-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.089392
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35.089392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: