MEDICARE: DR. HARRY GREENE KENNEDY JR. 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
1	2085R0202X	Diagnostic Radiology Physician	ME93924	FL

General Provider Information

NPI Number	:	1245356179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY GREENE KENNEDY JR. M.D.

Provider Business Mailing Address
First Line	:	2011 S 25TH ST
Second Line	:	SUITE 106
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4753
Country	:	US
Telephone Number	:	772-468-7020
Fax Number	:	772-468-7698

Provider Business Practice Location Address
First Line	:	2011 S 25TH ST
Second Line	:	SUITE 106
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4753
Country	:	US
Telephone Number	:	772-468-7020
Fax Number	:	772-468-7698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	09/18/2012

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