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General NPI Number Information
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NPI Number | 1538140744
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Entity Type | Individual
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Provider Name | COLLEEN M KENNEDY D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 75 BARCLAY CIR SUITE 225
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5820
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Country | US
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Telephone | 248-299-1892
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Fax | 248-299-2396
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Provider Business Mailing Address
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Address Line | 75 BARCLAY CIRCLE SUITE 225
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307
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Country | US
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Telephone | 248-299-1892
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Fax | 248-299-2396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101012334
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License Number State | MI
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