MEDICARE: KENDALL ERDAHL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35.090038	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427263292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL ERDAHL MD

Provider Business Mailing Address
First Line	:	600 W MAIN ST STE 330
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-3384
Country	:	US
Telephone Number	:	937-980-7400
Fax Number	:	937-980-7409

Provider Business Practice Location Address
First Line	:	600 W MAIN ST STE 330
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-3384
Country	:	US
Telephone Number	:	937-980-7400
Fax Number	:	937-980-7409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	01/12/2021

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Directions to “ KENDALL ERDAHL MD” Practice Location

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