Healthcare Provider Details

I. General information

NPI: 1326121294
Provider Name (Legal Business Name): ACADIA FOOT & ANKLE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOUNT HOPE AVE STE 620
BANGOR ME
04401-3667
US

IV. Provider business mailing address

700 MOUNT HOPE AVE STE 620
BANGOR ME
04401-3667
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-2220
  • Fax: 207-947-4073
Mailing address:
  • Phone: 207-947-2220
  • Fax: 207-947-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD181
License Number StateME

VIII. Authorized Official

Name: KEITH S KENDALL
Title or Position: OWNER
Credential: DPM
Phone: 207-947-2220