Individual
DR. STEPHEN D KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5838 W BRICK RD STE 106, SOUTH BEND, IN 46628
(574) 247-1911
(574) 247-1912
Mailing address
5838 W BRICK RD STE 106, SOUTH BEND, IN 46628-8420
(574) 247-1911
(574) 247-1912
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001650A
IN
207Q00000X
Family Medicine Physician
5101013733
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200081840A
—
IN
Enumeration date
07/15/2005
Last updated
02/22/2019
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