Individual
BERNARD V KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
700 S PARK ST, DEAN MEDICAL CENTER, MADISON, WI 53715-1830
(608) 258-6975
(608) 258-5222
Mailing address
700 S PARK ST, DEAN MEDICAL CENTER, MADISON, WI 53715-1830
(608) 258-6975
(608) 258-5222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
543
WI
363AM0700X
Medical Physician Assistant
543-023
WI
363AS0400X
Surgical Physician Assistant
543-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629051446
—
WI
Enumeration date
11/25/2005
Last updated
12/15/2020
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