Individual
TIMOTHY J KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 GREENBRIER RD STE 240, GREEN BAY, WI 54311-6519
(920) 288-8280
(920) 288-8285
Mailing address
2034 SHADY LN, GREEN BAY, WI 54313-9313
(920) 621-1785
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
29987
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104386126
—
MI
05
—
104386153
—
MI
05
—
31501900
—
WI
01
—
340015995
RAILROAD
WI
01
—
3402100592
BCBS
MI
Enumeration date
06/28/2006
Last updated
06/01/2021
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