MEDICARE: DR. KENAN KIRKENDALL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	3310	OK
2	207R00000X	Internal Medicine Physician	3310	OK
3	208000000X	Pediatrics Physician	3310	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316949563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENAN KIRKENDALL D.O.

Provider Business Mailing Address
First Line	:	1501 MAIN ST
Second Line	:
City	:	WOODWARD
State	:	OK
Zip	:	73801-3043
Country	:	US
Telephone Number	:	580-254-5316
Fax Number	:	580-256-6508

Provider Business Practice Location Address
First Line	:	1501 MAIN ST
Second Line	:
City	:	WOODWARD
State	:	OK
Zip	:	73801-3043
Country	:	US
Telephone Number	:	580-254-5316
Fax Number	:	580-256-6508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/27/2012

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