Individual
MICHAEL S KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8990 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5884
(763) 398-0099
(763) 398-0124
Mailing address
11490 SILVEROD ST NW, COON RAPIDS, MN 55433-2640
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 093139-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260743300
—
MN
01
—
3T738KE
BCBSMN
MN
Enumeration date
08/12/2005
Last updated
05/15/2008
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