MEDICARE: DR. JESSICA 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
1	207R00000X	Internal Medicine Physician	036130011	IL

General Provider Information

NPI Number	:	1932332731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA M. KENNEDY M.D.

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR STE 118
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-8701
Country	:	US
Telephone Number	:	312-470-8990
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR STE 118
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-8701
Country	:	US
Telephone Number	:	312-470-8990
Fax Number	:

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

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	10/11/2024

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