Healthcare Provider Details

I. General information

NPI: 1457355083
Provider Name (Legal Business Name): KENDRICK B BASHOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 GRAHAM RD SUITE B
CUYAHOGA FALLS OH
44223-1205
US

IV. Provider business mailing address

40 MUNROE FALLS AVE
MUNROE FALLS OH
44262-1538
US

V. Phone/Fax

Practice location:
  • Phone: 330-923-0553
  • Fax: 330-923-0556
Mailing address:
  • Phone: 330-923-0553
  • Fax: 330-923-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35063767B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: