Kennedy, Stephen D

Kennedy, Stephen D is an individual health care provider with primary practice located at 1694 W Logansport Rd , Peru IN 46970-3149. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Kennedy, Stephen D can be contacted via phone (765) 472-2812.

Contact Information

Primary practice address
1694 W Logansport Rd Peru IN 46970-3149
Phone: (765) 472-2812
Fax: (765) 472-2970
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01044433 Indiana

Profile Details

NPI number 1700957123
LBN Legal business name Kennedy, Stephen D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2006
Last updated Apr 7th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700957123 NPPES
Indiana MEDICAID 200091180 B
Indiana Other P01418893

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