Kennedy, Timothy J

Kennedy, Timothy J is an individual health care provider with primary practice located at 2845 Greenbrier Rd Ste 240 , Green Bay WI 54311-6519. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Kennedy, Timothy J can be contacted via phone (920) 288-8280.

Contact Information

Primary practice address
2845 Greenbrier Rd Ste 240 Green Bay WI 54311-6519
Phone: (920) 288-8280
Fax: (920) 288-8285
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 29987 Wisconsin

Profile Details

NPI number 1417985631
LBN Legal business name Kennedy, Timothy J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2006
Last updated Jun 1st, 2021 - about 3 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 1417985631 NPPES
Michigan Other 3402100592 BCBS
Michigan MEDICAID 104386126 BCBS
Michigan MEDICAID 31501900 BCBS
Michigan Other 340015995 BCBS
Michigan MEDICAID 104386153 BCBS

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