Individual
CAROL A KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1601 BRIGHAM DR, SUITE 200, PERRYSBURG, OH 43551-7114
(419) 872-7700
(419) 874-0196
Mailing address
1620 BRIGHAM DR STE 240, PERRYSBURG, OH 43551-7124
(419) 872-7700
(419) 874-0196
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
34057194
OH
208000000X
Pediatrics Physician
35057194
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141232
ANTHEM
OH
01
—
00625
PHC
OH
01
—
0634374
AETNA
OH
05
—
0741344
—
OH
01
—
12-01218
UHC
OH
Enumeration date
08/16/2005
Last updated
12/28/2023
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