Provider Demographics
NPI:1013119007
Name:KENNEDY, TERENCE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:JAMES
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 1:733 W LATOKA DR SW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-9376
Mailing Address - Country:US
Mailing Address - Phone:320-762-2526
Mailing Address - Fax:
Practice Address - Street 1:733 W LATOKA DR SW
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-9376
Practice Address - Country:US
Practice Address - Phone:320-762-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21953207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery