Basic Information
| Provider Information | |||||||||
| NPI: | 1245613892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 CATHERINE STREET | ||||||||
| Address2: | 4232 MED SCI I | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347643270 | ||||||||
| FaxNumber: | 7346152964 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 CATHERINE STREET | ||||||||
| Address2: | 4232 MED SCI I | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347643270 | ||||||||
| FaxNumber: | 7346152964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207ZP0102X | 042.0014730 | VT | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.