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NPI Code Detail

MEDICARE: DR. KATHLEEN M KENNEDY M.D.

MEDICARE: DR. KATHLEEN M KENNEDY 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
1207R00000XInternal Medicine PhysicianME00053395FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
107334OTHERFLFL BC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538179262
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHLEEN M KENNEDY M.D.
Provider Business Mailing Address
First Line : PO BOX 863407
Second Line :
City : ORLANDO
State : FL
Zip : 32886-3407
Country : US
Telephone Number : 941-917-2600
Fax Number : 941-917-7884
Provider Business Practice Location Address
First Line : 1825 DR MARTIN LUTHER KING WAY
Second Line :
City : SARASOTA
State : FL
Zip : 34234-2525
Country : US
Telephone Number : 941-952-4123
Fax Number : 941-952-4101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 07/21/2022

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