Provider Demographics
NPI:1629188941
Name:STEPHEN KENNEDY, MD, INC.
Entity Type:Organization
Organization Name:STEPHEN KENNEDY, MD, INC.
Other - Org Name:ELK GROVE BONE DENSITOMETRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-691-2069
Mailing Address - Street 1:9300 W STOCKTON BLVD
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8070
Mailing Address - Country:US
Mailing Address - Phone:916-691-2069
Mailing Address - Fax:916-691-2065
Practice Address - Street 1:9300 W STOCKTON BLVD
Practice Address - Street 2:SUITE # 104
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8070
Practice Address - Country:US
Practice Address - Phone:916-691-2069
Practice Address - Fax:916-691-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 860612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689668279OtherMEDICARE NPI - INDIVIDUAL FOR DR. STEPHEN KENNEDY
1689668279OtherMEDICARE NPI - INDIVIDUAL FOR DR. STEPHEN KENNEDY