Provider Demographics
NPI:1184611956
Name:KENNEDY, ERIN M (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:M
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7864
Mailing Address - Country:US
Mailing Address - Phone:563-589-9119
Mailing Address - Fax:563-552-2800
Practice Address - Street 1:3395 LAKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7864
Practice Address - Country:US
Practice Address - Phone:563-589-9119
Practice Address - Fax:563-552-2800
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31852208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAF23787Medicare UPIN
IA08636Medicare ID - Type Unspecified