Provider Demographics
NPI:1558324160
Name:KENNEDY, MERLE L (MD)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:L
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 1:560 N CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9105
Mailing Address - Country:US
Mailing Address - Phone:614-839-2300
Mailing Address - Fax:614-839-2301
Practice Address - Street 1:560 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9105
Practice Address - Country:US
Practice Address - Phone:614-839-2300
Practice Address - Fax:614-839-2301
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047762K207X00000X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000120033OtherANTHEM PIN
OH09-00371OtherUHC PIN
OH4066846OtherAETNA PIN
OHKE0731251OtherRAILROAD MEDICARE
OH854875Medicaid
OH1881292-002OtherCIGNA PIN
OH1376868448OtherMEDICARE DME
OH1881292-002OtherCIGNA PIN
OHKE0731251Medicare PIN