MEDICARE: MICHAEL DUSTIN KENNEDY D.O.

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	O-320	ID
2	207Q00000X	Family Medicine Physician	0102202027	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1649346081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DUSTIN KENNEDY D.O.

Provider Business Mailing Address
First Line	:	450 GIBNER RD STE 1
Second Line	:
City	:	CARLISLE BARRACKS
State	:	PA
Zip	:	17013-5086
Country	:	US
Telephone Number	:	717-245-3400
Fax Number	:	877-846-6967

Provider Business Practice Location Address
First Line	:	450 GIBNER RD STE 1
Second Line	:
City	:	CARLISLE BARRACKS
State	:	PA
Zip	:	17013-5086
Country	:	US
Telephone Number	:	717-245-3400
Fax Number	:	877-846-6967

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	02/14/2023

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Directions to “ MICHAEL DUSTIN KENNEDY D.O.” Practice Location

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