Healthcare Provider Details

I. General information

NPI: 1003779935
Provider Name (Legal Business Name): MR. KENDALL TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MADISON AVE STE 200
TOLEDO OH
43604-1230
US

IV. Provider business mailing address

500 MADISON AVE STE 200
TOLEDO OH
43604-1230
US

V. Phone/Fax

Practice location:
  • Phone: 704-712-9054
  • Fax: 704-712-9054
Mailing address:
  • Phone: 704-712-9054
  • Fax: 704-712-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: