Provider Demographics
NPI:1831135029
Name:KENNEDY, CYNTHIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:SUITE 350W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-238-6161
Mailing Address - Fax:406-238-6171
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 350W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6161
Practice Address - Fax:406-238-6171
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT8566207Y00000X
WYWY6264A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114598300Medicaid
MT0014416Medicaid
MT0000018581OtherMT BC/BS
MTG92211Medicare UPIN
MT0000018581OtherMT BC/BS