Healthcare Provider Details

I. General information

NPI: 1326049081
Provider Name (Legal Business Name): BETSY L KENDIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 06/24/2024
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 CONVENIENCE CIR NW STE 100
CANTON OH
44718-2686
US

IV. Provider business mailing address

3951 CONVENIENCE CIR NW STE 100
CANTON OH
44718-2686
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-9944
  • Fax: 330-499-3056
Mailing address:
  • Phone: 330-499-9944
  • Fax: 330-499-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number35070944
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35070944
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35070944
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: