MEDICARE: KENDALL LANE FLANIGAN MD

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	207N00000X	Dermatology Physician	2025-02105	NC

General Provider Information

NPI Number	:	1679154603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL LANE FLANIGAN MD

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	7903 PROVIDENCE RD STE 125
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8911
Country	:	US
Telephone Number	:	704-727-7355
Fax Number	:	704-900-2216

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

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	08/25/2025

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Directions to “ KENDALL LANE FLANIGAN MD” Practice Location

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