Provider Demographics
NPI:1669496022
Name:KENNEDY, ALLAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALLAN
Other - Middle Name:LAURENCE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:CLEVELAND CLINIC-DESK F-20
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:216-445-8645
Mailing Address - Fax:216-442-5124
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:CLEVELAND CLINIC- DESK F-20
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-445-8645
Practice Address - Fax:216-442-5124
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84785207RE0101X
OH35.093575207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253113500Medicaid
FL68848Medicare ID - Type Unspecified
FL253113500Medicaid