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NPI Code Detail

MEDICARE: SUSAN KENNEDY DO

MEDICARE: SUSAN 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
1207Q00000XFamily Medicine Physician02732IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
159346OTHERIAMEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number : 1720095276
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN KENNEDY DO
Provider Business Mailing Address
First Line : 1200 UNIVERSITY AVE STE 200
Second Line :
City : DES MOINES
State : IA
Zip : 50314-2355
Country : US
Telephone Number : 515-248-1447
Fax Number : 515-248-1440
Provider Business Practice Location Address
First Line : 2353 SE 14TH ST
Second Line :
City : DES MOINES
State : IA
Zip : 50320-1109
Country : US
Telephone Number : 515-248-1400
Fax Number : 515-248-1414
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 05/01/2018

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Directions to “ SUSAN KENNEDY DO” Practice Location

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