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NPI Code Detail

MEDICARE: DR. ERIN M KENNEDY MD

MEDICARE: DR. ERIN M KENNEDY MD
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
1208200000XPlastic Surgery Physician31852IA

General Provider Information

NPI Number : 1184611956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIN M KENNEDY MD
Provider Business Mailing Address
First Line : 3395 LAKE RIDGE DR
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-7864
Country : US
Telephone Number : 563-589-9119
Fax Number : 563-552-2800
Provider Business Practice Location Address
First Line : 3395 LAKE RIDGE DR
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-7864
Country : US
Telephone Number : 563-589-9119
Fax Number : 563-552-2800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 05/21/2025

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