Individual
DR. STEPHEN D KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
751 W 2ND ST STE 100, PERU, IN 46970-1385
(765) 919-4378
(765) 919-4672
Mailing address
751 W 2ND ST STE 100, PERU, IN 46970-1385
(765) 919-4378
(765) 919-4672
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01044433
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200091180 B
—
IN
01
—
P01418893
RR MEDICARE
IN
Enumeration date
11/10/2006
Last updated
08/16/2024
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