Healthcare Provider Details

I. General information

NPI: 1669268397
Provider Name (Legal Business Name): KINDBODY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 PROVIDENCE RD
CHARLOTTE NC
28207
US

IV. Provider business mailing address

1455 N MILWAUKEE AVE FL 2
CHICAGO IL
60622-2015
US

V. Phone/Fax

Practice location:
  • Phone: 980-242-5345
  • Fax: 980-895-4525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIANNE F DEBENEDICTIS
Title or Position: SVP, PAYOR RELATIONS
Credential:
Phone: 713-254-3601