Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0890 | TX |
NPI | 1356343214 |
---|---|
Provider Name | Dr. Michael Welt Kendall |
First Address | Amarillo, TX 79124-1607 |
Second Address | Amarillo, TX 79124-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 28/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0897191-01 | (05) | TX |
T14158 | (02) | TX |