1992985550 NPI number — DR. MICHAEL ARTHUR KENNEDY MD

Table of content: DR. MICHAEL ARTHUR KENNEDY MD (NPI 1992985550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992985550 NPI number — DR. MICHAEL ARTHUR KENNEDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEDY
Provider First Name:
MICHAEL
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992985550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 PEOPLES PLZ
Provider Second Line Business Mailing Address:
#287
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-4798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-388-4424
Provider Business Mailing Address Fax Number:
302-834-0933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 N. CHAPEL ST, #100
Provider Second Line Business Practice Location Address:
PHYSICIANS GROUP, LLC
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19711-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-737-6099
Provider Business Practice Location Address Fax Number:
302-737-6299
Provider Enumeration Date:
11/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  MD059935-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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