Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POD 1057 | ME |
N | 222Z00000X | Podiatrist | POD 1057 | ME |
Y | 213E00000X | Podiatrist | POD1057 | ME |
Y | 222Z00000X | Podiatrist | POD1057 | ME |
N | 2081S0010X | Sports Medicine | POD 1057 | ME |
N | 213ES0000X | Sports Medicine | POD 1057 | ME |
N | 213ES0103X | Foot & Ankle Surgery | POD 1057 | ME |
NPI | 1164490009 |
---|---|
Provider Name | Keith S Kendall |
First Address | Bangor, ME 04401-5671 |
Second Address | Bangor, ME 04401-5671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 26/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
431970899 | (05) | ME |
U91816 | (02) |