Provider Demographics
NPI:1093019200
Name:SUSAN J. KENNEDY, MD, PC
Entity Type:Organization
Organization Name:SUSAN J. KENNEDY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-971-8815
Mailing Address - Street 1:2301 S HURON PKWY
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5133
Mailing Address - Country:US
Mailing Address - Phone:734-971-8815
Mailing Address - Fax:734-971-8881
Practice Address - Street 1:2301 S HURON PKWY
Practice Address - Street 2:SUITE 3D
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5133
Practice Address - Country:US
Practice Address - Phone:734-971-8815
Practice Address - Fax:734-971-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029292207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty