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General NPI Number Information
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NPI Number | 1093019200
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Entity Type | Organization
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Legal Business Name | SUSAN J. KENNEDY, MD, PC
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 2301 S HURON PKWY SUITE 3D
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City | ANN ARBOR
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State | MI
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Zip | 48104-5133
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Country | US
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Telephone | 734-971-8815
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Fax | 734-971-8881
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Provider Business Mailing Address
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Address Line | 2301 S HURON PKWY SUITE 3D
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City | ANN ARBOR
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State | MI
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Zip | 48104-5133
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Country | US
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Telephone | 734-971-8815
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Fax | 734-971-8881
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | SHERYL ANN FELICE
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Credential |
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Telephone | 734-971-8815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 4301029292
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License Number State | MI
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