Provider Demographics
NPI:1407836844
Name:KENNEDY, TIMOTHY D (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 COLLEGE BLVD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1845
Mailing Address - Country:US
Mailing Address - Phone:913-319-8400
Mailing Address - Fax:913-696-0040
Practice Address - Street 1:4801 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2929
Practice Address - Country:US
Practice Address - Phone:816-561-5151
Practice Address - Fax:816-841-0373
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3230639AOtherRAILROAD MEDICARE- INDIV
KS3230639BOtherRAILROAD MEDICARE- INDIV
KSCI2562OtherRAILROAD MEDICARE- GROUP
MOCI3618OtherRAILROAD MEDICARE- GROUP
MO3230639AOtherRAILROAD MEDICARE- INDIV
KS3230639BMedicare PIN
KS3230639BOtherRAILROAD MEDICARE- INDIV