Organization
DR MICHAEL KENNEDY FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL PATRICK KENNEDY M.D. (CEO OWNER)
(337) 886-1200
Entity
Organization
Contact information
Practice address
111 SAINT CHARLES ST, CARENCRO, LA 70520-4004
(337) 886-1200
(337) 886-0919
Mailing address
111 SAINT CHARLES ST, CARENCRO, LA 70520-4004
(337) 886-1200
(337) 886-0919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD018238
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10990532
CAQH
LA
05
—
1377104
—
LA
01
—
7299329
AETNA
LA
01
—
F4181
BLUE CROSS BLUE SHIELD
LA
Enumeration date
08/10/2006
Last updated
12/09/2009
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