Individual
DR. MICHAEL GEORGE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
363 S RANDALL RD, ELGIN, IL 60123-5526
(847) 888-1555
Mailing address
363 S RANDALL RD, ELGIN, IL 60123-5526
(847) 888-1555
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010127
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508088683
GROUP NPI FOR BCBS
IL
01
—
1891842464
OTHER NPI
IL
01
—
36-3546473
TAX ID
IL
01
—
4515286
BCBS
IL
Enumeration date
07/15/2008
Last updated
09/10/2012
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