Individual
DR. MARK E KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
345 CLYDE MORRIS BLVD, SUITE 330, ORMOND BEACH, FL 32174-3111
(386) 672-4244
(386) 672-0603
Mailing address
345 CLYDE MORRIS BLVD, SUITE 330, ORMOND BEACH, FL 32174-3111
(386) 672-4244
(386) 672-0603
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME0075020
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18778423210
UNITED HEALTH CARE
FL
01
—
2150833
AETNA
FL
05
—
259857400
—
FL
Enumeration date
05/15/2006
Last updated
03/07/2023
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