Healthcare Provider Details

I. General information

NPI: 1639284284
Provider Name (Legal Business Name): BRENT WAYNE KINDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 HOSPITAL DRIVE SUITE 200
BATAVIA OH
45103-1981
US

IV. Provider business mailing address

2055 HOSPITAL DRIVE SUITE 200
BATAVIA OH
45103-1981
US

V. Phone/Fax

Practice location:
  • Phone: 513-735-1701
  • Fax: 513-735-8995
Mailing address:
  • Phone: 513-735-1701
  • Fax: 513-735-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA78352
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.090338
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA78352
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.090338
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA78352
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.090338
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: