MEDICARE: KEVIN KENDZIERSKI M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	35.080641	OH
2	208D00000X	General Practice Physician	35. 080641	OH

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	080139052	OTHER	OH	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	605424	OTHER	OH	BUCKEYE
4	000000213037	OTHER	OH	ANTHEM
6	01973	OTHER	OH	PARAMOUNT

NPI Number	:	1629053681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN KENDZIERSKI M.D.

Provider Business Mailing Address
First Line	:	3440 ISLAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-4343
Country	:	US
Telephone Number	:	419-340-1289
Fax Number	:	419-972-4203

Provider Business Practice Location Address
First Line	:	3440 ISLAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614
Country	:	US
Telephone Number	:	419-340-1289
Fax Number	:	419-972-4203

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	08/29/2018

3000 ARLINGTON AVE
TOLEDO, OH
43614-2595

Practice Phone: 419-383-4000
Practice Fax: