MEDICARE: WENDY K KENNEDY DPM

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	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	07000900A	IN

General Provider Information

NPI Number	:	1407841463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY K KENNEDY DPM

Provider Business Mailing Address
First Line	:	PO BOX 3402
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-0402
Country	:	US
Telephone Number	:	812-234-4243
Fax Number	:	812-478-3663

Provider Business Practice Location Address
First Line	:	1024 S 6TH ST
Second Line	:	SUITE 102
City	:	TERRE HAUTE
State	:	IN
Zip	:	47807-5015
Country	:	US
Telephone Number	:	812-232-3338
Fax Number	:	812-234-8828

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	10/19/2011

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Directions to “ WENDY K KENNEDY DPM” Practice Location

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