Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 40561 | MN |
NPI | 1023080751 |
---|---|
Provider Name | Michelle S Kennedy |
First Address | Minneapolis, MN 55414-0909 |
Second Address | Saint Paul, MN 55114-1052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 05/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G63817 | (02) | MN |