Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 35.080641 | OH |
N | 208D00000X | General Practice Physician | 35. 080641 | OH |
NPI | 1629053681 |
---|---|
Provider Name | Kevin Kendzierski |
First Address | Toledo, OH 43614-4343 |
Second Address | Toledo, OH 43614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 29/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000213037 | ANTHEM (01) | OH |
01973 | PARAMOUNT (01) | OH |
080139052 | RAILROAD MEDICARE (01) | OH |
104719902 | (05) | MI |
2426860 | (05) | OH |
605424 | BUCKEYE (01) | OH |
H90295 | (02) | OH |