| Timothy J Kennedy, MD | |
|
2845 Greenbrier Rd Ste 240, Green Bay, WI 54311-6519 | |
| (920) 288-8280 | |
| (920) 288-8285 |
| Full Name | Timothy J Kennedy |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Location | 2845 Greenbrier Rd Ste 240, Green Bay, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417985631 | NPI | - | NPPES |
| 3402100592 | Other | MI | BCBS |
| 104386126 | Medicaid | MI | |
| 31501900 | Medicaid | WI | |
| 340015995 | Other | WI | RAILROAD |
| 104386153 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 29987 (Wisconsin) | Primary |
| Entity Name | Baycare Clinic Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1588609648 PECOS PAC ID: 4385554328 Enrollment ID: O20031105000087 |
| Mailing Address | Practice Location Address |
|---|---|
| Timothy J Kennedy, MD 2034 Shady Ln, Green Bay, WI 54313-9313 Ph: (920) 621-1785 | Timothy J Kennedy, MD 2845 Greenbrier Rd Ste 240, Green Bay, WI 54311-6519 Ph: (920) 288-8280 |
Heather M Stefaniak, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 2845 Greenbrier Rd Ste 240, Green Bay, WI 54311 Phone: 920-288-8280 Fax: 920-288-8285 | |
Richard Windsor, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 2845 Greenbrier Rd, Suite 240, Green Bay, WI 54311 Phone: 920-288-8280 Fax: 920-288-8285 | |
Bruce M Neal, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 2845 Greenbrier Rd Ste 240, Green Bay, WI 54311 Phone: 920-288-8280 Fax: 920-288-8285 | |
Dr. Vannhu Nguyen, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 2845 Greenbrier Rd, Ste 240, Green Bay, WI 54311 Phone: 920-288-8280 Fax: 920-288-8285 | |
Bahareh Nicole Alavi-dunn, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 1821 S Webster Ave, Green Bay, WI 54301 Phone: 920-436-1359 | |
William Scott Dougherty, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 2845 Greenbrier Rd Ste 240, Green Bay, WI 54311 Phone: 920-288-8280 Fax: 920-288-8285 |