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General NPI Number Information
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NPI Number | 1780665448
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Entity Type | Individual
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Provider Name | JOHN WAYNE KENNEDY MD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 1614 N BALDWIN AVE
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City | MARION
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State | IN
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Zip | 46952-1437
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Country | US
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Telephone | 765-664-9000
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Fax | 765-391-1521
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Provider Business Mailing Address
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Address Line | 1614 N BALDWIN AVE
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City | MARION
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State | IN
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Zip | 46952-1437
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Country | US
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Telephone | 765-664-9000
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Fax | 765-391-1521
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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 | 01022780
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01022780A
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License Number State | IN
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