MEDICARE: ROSEMARIE 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	208000000X	Pediatrics Physician	4301059498	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3502510121	OTHER	MI	BLUE CROSS BLUE SHIELD
2	1009249	OTHER	MI	MCLAREN HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4941624003	OTHER	MI	CIGNA
5	H91967	OTHER	MI	HEALTH NET FEDERAL
6	1009249	OTHER	MI	HEALTH ADVANTAGE NETWORK
7	H91967	OTHER	MI	HEALTH ALLIANCE PLAN
8	P00076880/CD3612	OTHER	MI	METRAHEALTH
9	0995963	OTHER	MI	HEALTH PLUS OF MI
10	5072036	OTHER	MA	AETNA
11	C5452	OTHER	MI	MCARE

General Provider Information

NPI Number	:	1982694238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARIE KENNEDY MD

Provider Business Mailing Address
First Line	:	401 S BALLENGER HWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3638
Country	:	US
Telephone Number	:	810-342-1000
Fax Number	:	810-342-1590

Provider Business Practice Location Address
First Line	:	2420 OWEN RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-3417
Country	:	US
Telephone Number	:	810-496-2500
Fax Number	:	810-629-0415

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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Directions to “ ROSEMARIE KENNEDY MD” Practice Location

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