Provider Demographics
NPI:1003814955
Name:MCKENDRICK, ALASDAIR IL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALASDAIR
Middle Name:IL
Last Name:MCKENDRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-557-8780
Mailing Address - Fax:248-557-3242
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-557-8780
Practice Address - Fax:248-557-3242
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAM033769208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102712OtherPREFERRED/CARE CHOICES
MI2836795Medicaid
MIC3934OtherM-CARE
MI101940OtherGREAT LAKES HEALTH PLAN
MI9726231001OtherCIGNA
MI10116320001OtherTHE WELLNESS PLAN
MI4262359OtherAETNA
MI21874OtherOMNICARE
MI791281006Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI9726231001OtherCIGNA
MI101940OtherGREAT LAKES HEALTH PLAN