Provider Demographics
NPI:1124016738
Name:FENDELL, HOWARD S (DPM)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:S
Last Name:FENDELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4708
Mailing Address - Country:US
Mailing Address - Phone:954-456-8100
Mailing Address - Fax:954-456-6246
Practice Address - Street 1:1931 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4708
Practice Address - Country:US
Practice Address - Phone:954-456-8100
Practice Address - Fax:954-456-6246
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01672213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
89719OtherBCBS
FL390018500Medicaid
89719OtherBCBS
T55604Medicare UPIN