Individual
DR. MICHAEL B. KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1901 W CLINCH AVE, KNOXVILLE, TN 37916-2307
(865) 541-1111
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD16396
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3029179
—
TN
01
—
3152900
BLUE CROSS
TN
05
—
3829732
—
TN
01
—
4154443
BLUE CROSS
TN
01
—
P00254475
RAILROAD MEDICARE
TN
Enumeration date
06/08/2006
Last updated
11/29/2007
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