Individual
SHAUN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1575 BEAM AVE, MAPLEWOOD, MN 55109-2502
(651) 232-7348
Mailing address
800 EAST 28TH ST MR 11112, MINNEAPOLIS, MN 55407
(612) 863-6590
(612) 863-5247
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
59164
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
MN
Other
Enumeration date
06/26/2012
Last updated
07/21/2022
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