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Individual
TIMOTHY J KENNEDY
Active
Individual
TIMOTHY J KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
29987
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104386126
—
MI
05
—
104386153
—
MI
05
—
31501900
—
WI
01
—
340015995
RAILROAD
WI
01
—
3402100592
BCBS
MI
Enumeration date
06/28/2006
Last updated
06/01/2021
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