Provider Demographics
NPI:1245298512
Name:KENNEDY, ALLAN LINORD (DO)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:LINORD
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0058
Mailing Address - Country:US
Mailing Address - Phone:866-898-7139
Mailing Address - Fax:616-975-9824
Practice Address - Street 1:400 HOBART ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2331
Practice Address - Country:US
Practice Address - Phone:231-876-7245
Practice Address - Fax:231-876-7625
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010806207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK010806OtherBCBS
MI114951858Medicaid
MI114150481Medicaid
MI114400109Medicaid
G56064Medicare UPIN
N51120-002Medicare ID - Type Unspecified
M87150007Medicare ID - Type Unspecified
P38800002Medicare PIN
MI114150481Medicaid