# DR MICHAEL KENNEDY FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740291624
- **Authorized official:** DR. MICHAEL PATRICK KENNEDY M.D. (CEO OWNER)
- **Authorized official phone:** (337) 886-1200

## Contact information

- **Practice address:** 111 SAINT CHARLES ST, CARENCRO, LA 70520-4004
- **Practice address phone:** (337) 886-1200
- **Practice address fax:** (337) 886-0919
- **Mailing address:** 111 SAINT CHARLES ST, CARENCRO, LA 70520-4004
- **Mailing address phone:** (337) 886-1200
- **Mailing address fax:** (337) 886-0919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD018238 | LA | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 12/09/2009

## 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 |