MEDICARE: DR. LOREN S. KENDIS M.D.

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	207R00000X	Internal Medicine Physician	35046109	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	:	1861431348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOREN S. KENDIS M.D.

Provider Business Mailing Address
First Line	:	6555 WILSON MILLS RD
Second Line	:	SUITE 103
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3435
Country	:	US
Telephone Number	:	440-442-8313
Fax Number	:	440-442-8316

Provider Business Practice Location Address
First Line	:	6555 WILSON MILLS RD
Second Line	:	SUITE 103
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3435
Country	:	US
Telephone Number	:	440-442-8313
Fax Number	:	440-442-8316

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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