Provider Demographics
NPI:1841366770
Name:KENNEDY, NEIL (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
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 1:8200 E 34TH CIR N
Mailing Address - Street 2:STE 1404
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1361
Mailing Address - Country:US
Mailing Address - Phone:608-203-5201
Mailing Address - Fax:
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:ATTN: MADISON RADIOLOGISTS, S.C.
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-251-6100
Practice Address - Fax:608-826-2710
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA976312085R0202X
MO20030075532085R0202X
WI51546-0202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35111800Medicaid
CAP00606385OtherRAILROAD MEDICARE
WI004015045Medicare PIN
CAP00606385OtherRAILROAD MEDICARE
WI35111800Medicaid