Provider Demographics
NPI:1992985550
Name:KENNEDY, MICHAEL ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:560 PEOPLES PLZ
Mailing Address - Street 2:#287
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4798
Mailing Address - Country:US
Mailing Address - Phone:302-388-4424
Mailing Address - Fax:302-834-0933
Practice Address - Street 1:62 N. CHAPEL ST, #100
Practice Address - Street 2:PHYSICIANS GROUP, LLC
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-2238
Practice Address - Country:US
Practice Address - Phone:302-737-6099
Practice Address - Fax:302-737-6299
Is Sole Proprietor?:No
Enumeration Date:2007-11-11
Last Update Date:2010-09-09
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Provider Licenses
StateLicense IDTaxonomies
PAMD059935-L2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF72294Medicare UPIN
PA026907Medicare PIN