TIMOTHY J KENNEDY MD NPI 1417985631

NPI Information

NPI: 1417985631
Provider Name: TIMOTHY J KENNEDY, MD
Classification: Urology - 208800000X
Entity Type: Individual

PECOS Registration: Yes

Address:
2845 GREENBRIER RD STE 240
GREEN BAY, WI
ZIP 54311
Phone: (920) 288-8280
Get Directions

Timothy J Kennedy, MD is an urology in Green Bay, WI. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. Timothy J Kennedy, MD NPI is 1417985631. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2845 GREENBRIER RD STE 240
GREEN BAY, WI
ZIP 54311-519
Phone: (920) 288-8280
Fax: (920) 288-8285

The NPI 1417985631 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/28/2006 and was last updated on 6/1/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208800000X	Urology		29987	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3402100592	OTHER	MICHIGAN	BCBS
2	31501900	MEDICAID	WISCONSIN
3	104386126	MEDICAID	MICHIGAN
4	104386153	MEDICAID	MICHIGAN
5	340015995	OTHER	WISCONSIN	RAILROAD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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