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General NPI Number Information
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NPI Number | 1417208257
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Entity Type | Organization
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Legal Business Name | TIMOTHY C KENNEDY MD LLC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 2045 ASH ST
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City | DENVER
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State | CO
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Zip | 80207-3717
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Country | US
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Telephone | 720-244-6340
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Fax | 303-321-7033
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Provider Business Mailing Address
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Address Line | 2045 ASH ST
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City | DENVER
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State | CO
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Zip | 80207-3717
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Country | US
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Telephone | 720-244-6340
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Fax | 303-321-7033
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY C KENNEDY
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Credential | MD.
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Telephone | 720-244-6340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 18011
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License Number State | CO
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