MEDICARE: KENNEDY FOOT CARE LLC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1588737183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEDY FOOT CARE LLC

Provider Business Mailing Address
First Line	:	888 E CAMBRIDGE DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-9344
Country	:	US
Telephone Number	:	317-554-7709
Fax Number	:

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	:	317-554-7709
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WENDY KENNEDY
Credential	:	DPM
Telephone Number	:	317-554-7709

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/26/2011

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Directions to “KENNEDY FOOT CARE LLC ” Practice Location

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