Individual
DR. TRACY MARTIG KENNETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1423 N NATIONAL AVE, SPRINGFIELD, MO 65802-2047
(417) 269-6583
(417) 269-6573
Mailing address
1304 E REPUBLIC RD, SPRINGFIELD, MO 65804-7210
(417) 269-6583
(417) 269-6573
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2001004533
MO
207P00000X
Emergency Medicine Physician
Primary
E-11413
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205227101
—
MO
Enumeration date
10/17/2005
Last updated
10/01/2018
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