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NPI Code Detail

MEDICARE: DR. JOHN C KENNEDY M.D.

MEDICARE: DR. JOHN C KENNEDY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianME79045FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134111677
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN C KENNEDY M.D.
Provider Business Mailing Address
First Line : 134 S WOODS DR
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-3262
Country : US
Telephone Number : 321-636-3066
Fax Number : 321-636-2545
Provider Business Practice Location Address
First Line : 134 S WOODS DR
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-3262
Country : US
Telephone Number : 321-636-3066
Fax Number : 321-636-2545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 03/30/2009

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Directions to “ DR. JOHN C KENNEDY M.D.” Practice Location

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