Kennedy, Michael George

Kennedy, Michael George is an individual health care provider with primary practice located at 363 S Randall Rd , Elgin IL 60123-5526. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Kennedy, Michael George can be contacted via phone (847) 888-1555.

Contact Information

Primary practice address
363 S Randall Rd Elgin IL 60123-5526
Phone: (847) 888-1555
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046010127 Illinois

Profile Details

NPI number 1417111790
LBN Legal business name Kennedy, Michael George
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 15th, 2008
Last updated Sep 10th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417111790 NPPES
Illinois Other 36-3546473 TAX ID
Illinois Other 1508088683 TAX ID
Illinois Other 4515286 TAX ID
Illinois Other 1891842464 TAX ID

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