Provider Demographics
NPI:1326008673
Name:KENNEDY, DAVID G (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 11795
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-0595
Mailing Address - Country:US
Mailing Address - Phone:314-743-0330
Mailing Address - Fax:314-743-0339
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 269C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-743-0330
Practice Address - Fax:314-743-0339
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR8B14207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13596Medicare UPIN
MO140002148Medicare PIN