MEDICARE: DR. STEPHEN WILLIAM KENNEDY MD

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	2471B0102X	Bone Densitometry Radiologic Technologist	A86061	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629188941	OTHER		MEDICARE NPI - ORGANIZATION

General Provider Information

NPI Number	:	1689668279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN WILLIAM KENNEDY MD

Provider Business Mailing Address
First Line	:	9300 W STOCKTON BLVD
Second Line	:	STE 104
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8070
Country	:	US
Telephone Number	:	916-691-2069
Fax Number	:	916-691-2065

Provider Business Practice Location Address
First Line	:	9300 W STOCKTON BLVD
Second Line	:	STE 104
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8070
Country	:	US
Telephone Number	:	916-691-2069
Fax Number	:	916-691-2065

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	11/09/2009

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