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NPI Code Detail

MEDICARE: ELIZABETH LYNN KENNEDY DO

MEDICARE:   ELIZABETH LYNN KENNEDY  DO
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
1207Q00000XFamily Medicine PhysicianMN52471MN
2207Q00000XFamily Medicine Physician5101015216MI

General Provider Information

NPI Number : 1215007414
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH LYNN KENNEDY DO
Provider Business Mailing Address
First Line : 675 WATER ST
Second Line :
City : EXCELSIOR
State : MN
Zip : 55331-3072
Country : US
Telephone Number : 952-906-7855
Fax Number :
Provider Business Practice Location Address
First Line : 675 WATER ST
Second Line :
City : EXCELSIOR
State : MN
Zip : 55331-3072
Country : US
Telephone Number : 952-906-7855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 02/09/2012

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Directions to “ ELIZABETH LYNN KENNEDY DO” Practice Location

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