Provider Demographics
NPI:1508074618
Name:KENNEDY, TABASSUM AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:TABASSUM
Middle Name:AHMED
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TABASSUM
Other - Middle Name:
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPARTMENT OF RADIOLOGY
Mailing Address - Street 2:600 HIGHLAND AVENUE
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-0001
Mailing Address - Country:US
Mailing Address - Phone:608-262-2122
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF RADIOLOGY
Practice Address - Street 2:600 HIGHLAND AVENUE
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-262-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040122552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology