MEDICARE: LATISHA KENDLE

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	3747P1801X	Personal Care Attendant	21-014857	IN

General Provider Information

NPI Number	:	1568289817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATISHA KENDLE

Provider Business Mailing Address
First Line	:	7190 RAMONA ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-2651
Country	:	US
Telephone Number	:	219-484-0819
Fax Number	:	918-238-1017

Provider Business Practice Location Address
First Line	:	2424 FRANKLIN ST STE 203
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4562
Country	:	US
Telephone Number	:	219-292-7555
Fax Number	:	918-238-1017

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

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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Directions to “ LATISHA KENDLE ” Practice Location

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