MEDICARE: KENDALL LITTLE 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	207Q00000X	Family Medicine Physician	23444	OK
2	207P00000X	Emergency Medicine Physician	23444	OK

General Provider Information

NPI Number	:	1891772307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL LITTLE MD

Provider Business Mailing Address
First Line	:	13309 UPPER POND CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-6215
Country	:	US
Telephone Number	:	405-708-2592
Fax Number	:

Provider Business Practice Location Address
First Line	:	13309 UPPER POND CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-6215
Country	:	US
Telephone Number	:	405-708-2592
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	08/25/2021

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Directions to “ KENDALL LITTLE MD” Practice Location

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