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Organization
DR MICHAEL KENNEDY FAMILY PRACTICE
Active
Organization
DR MICHAEL KENNEDY FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL PATRICK KENNEDY M.D. (CEO OWNER)
(337) 886-1200
Entity
Organization
Contact information
Practice address
111 SAINT CHARLES ST, CARENCRO, LA 70520-4004
(337) 886-1200
(337) 886-0919
Mailing address
111 SAINT CHARLES ST, CARENCRO, LA 70520-4004
(337) 886-1200
(337) 886-0919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD018238
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10990532
CAQH
LA
05
—
1377104
—
LA
01
—
7299329
AETNA
LA
01
—
F4181
BLUE CROSS BLUE SHIELD
LA
Enumeration date
08/10/2006
Last updated
12/09/2009
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