MEDICARE: DONALD E 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
1	207Q00000X	Family Medicine Physician	OS0004552	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82515	OTHER	FL	FL BC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447233408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD E KENNEDY DO

Provider Business Mailing Address
First Line	:	2460 OLD MOULTRIE RD
Second Line	:	STE 2
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-4198
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2625

Provider Business Practice Location Address
First Line	:	2450 TAMIAMI TRL
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-3922
Country	:	US
Telephone Number	:	941-624-2704
Fax Number	:	941-627-6066

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	12/04/2017

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Directions to “ DONALD E KENNEDY DO” Practice Location

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