Individual
JOHN WAYNE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1614 N BALDWIN AVE, MARION, IN 46952-1437
(765) 664-9000
(765) 391-1521
Mailing address
1614 N BALDWIN AVE, MARION, IN 46952-1437
(765) 664-9000
(765) 391-1521
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01022780
IN
208D00000X
General Practice Physician
Primary
01022780A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000286588
ANTHEM BCBS
IN
01
—
000000576122
BCBS
IN
01
—
000000697935
BCBS
IN
05
—
100123680
—
IN
Enumeration date
11/09/2005
Last updated
02/15/2013
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