Healthcare Provider Details

I. General information

NPI: 1285648097
Provider Name (Legal Business Name): RICHARD L KENDALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W PERRY ST
PORT CLINTON OH
43452-1010
US

IV. Provider business mailing address

135 W PERRY ST
PORT CLINTON OH
43452-1010
US

V. Phone/Fax

Practice location:
  • Phone: 419-732-7800
  • Fax: 419-797-4843
Mailing address:
  • Phone: 419-732-7800
  • Fax: 419-797-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35062349
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35062349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: