Provider Demographics
NPI:1134353881
Name:KENNEDY, CHAD MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MATTHEW
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1600 S COULTER ST
Mailing Address - Street 2:BUILDING B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1710
Mailing Address - Country:US
Mailing Address - Phone:806-355-1700
Mailing Address - Fax:806-355-1800
Practice Address - Street 1:1900 S COULTER ST STE P
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1795
Practice Address - Country:US
Practice Address - Phone:806-355-1700
Practice Address - Fax:806-355-1800
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4660207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387782YQXLMedicare UPIN