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General NPI Number Information
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NPI Number | 1164676433
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Entity Type | Organization
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Legal Business Name | MICHAEL P. KENNEDY, LLC
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 896 S BOARDWALK CT
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City | PALATINE
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State | IL
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Zip | 60067-7280
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Country | US
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Telephone | 847-859-5971
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Fax |
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Provider Business Mailing Address
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Address Line | 896 S BOARDWALK CT
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City | PALATINE
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State | IL
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Zip | 60067-7280
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Country | US
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Telephone | 847-859-5971
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL P. KENNEDY
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Credential | M.D.
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Telephone | 847-859-5971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036052393
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License Number State | IL
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