Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01062840A | IN |
NPI | 1104844919 |
---|---|
Provider Name | Dr. Corey B Kendall |
First Address | Indianapolis, IN 46278-1381 |
Second Address | Brownsburg, IN 46112-9354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200871610 | (05) | IN |