Provider Demographics
NPI:1164691150
Name:KENDALL, MERY A (MD)
Entity Type:Individual
Prefix:
First Name:MERY
Middle Name:A
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E COUNTY LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1046
Practice Address - Country:US
Practice Address - Phone:317-497-6333
Practice Address - Fax:317-497-6334
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066320A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200964080Medicaid
IN000000652750OtherANTHEM
IN000000680971OtherANTHEM
INP01157049OtherRR MEDICARE PTAN
INM400030050Medicare PIN
IN823720B1Medicare PIN
INP01157049OtherRR MEDICARE PTAN
IN000000680971OtherANTHEM
INM400023888Medicare PIN