Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101012647 | MI |
NPI | 1366417578 |
---|---|
Provider Name | Robert Jerome Kendell |
First Address | Cadillac, MI 49601-8482 |
Second Address | Cadillac, MI 49601-8481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4224164 | (05) | MI |