| Diana L Kennedy,md Inc | |
|
4205 Mcauley Blvd Ste 420 Oklahoma City OK 73120-8347 | |
| (405) 751-6117 | |
| (405) 751-0479 |
| Full Name | Diana L Kennedy,md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4205 Mcauley Blvd Ste 420, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Dana D Cavazos (MEDICAL ASSISTANT) |
| Authorized Official Contact | 4057516117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diana L Kennedy,md Inc 4205 Mcauley Blvd Ste 420 Oklahoma City OK 73120-8347 Ph: (405) 751-6117 | Diana L Kennedy,md Inc 4205 Mcauley Blvd Ste 420 Oklahoma City OK 73120-8347 Ph: (405) 751-6117 |
| NPI Number | 1154073765 |
|---|---|
| Provider Enumeration Date | 01/25/2022 |
| Last Update Date | 01/25/2022 |
| Medicare PECOS PAC ID | 0547652455 |
|---|---|
| Medicare Enrollment ID | O20220126000517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154073765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Diana L Kennedy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053429159 PECOS PAC ID: 5395910442 Enrollment ID: I20111219000634 |
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