MEDICARE: LEON KENDALL HOLDINGS, LLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1457582546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEON KENDALL HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	11501 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3313
Country	:	US
Telephone Number	:	305-646-3716
Fax Number	:	305-631-5056

Provider Business Practice Location Address
First Line	:	12515 SW 88TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1870
Country	:	US
Telephone Number	:	305-646-3716
Fax Number	:	305-631-5056

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	MR. BENJAMIN LEON III
Credential	:
Telephone Number	:	305-642-5366

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/06/2009

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