Healthcare Provider Details

I. General information

NPI: 1548562978
Provider Name (Legal Business Name): ROBERT KENDELL D.O.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8872 PROFESSIONAL DR SUITE A
CADILLAC MI
49601-8481
US

IV. Provider business mailing address

8872 PROFESSIONAL DR SUITE A
CADILLAC MI
49601-8481
US

V. Phone/Fax

Practice location:
  • Phone: 231-779-6260
  • Fax: 231-779-6264
Mailing address:
  • Phone: 231-779-6260
  • Fax: 231-779-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5101012647
License Number StateMI

VIII. Authorized Official

Name: MRS. SHELLY M HORINA
Title or Position: OFFICE MNGR/BILLER
Credential: CPC
Phone: 231-779-6260