Provider Demographics
NPI:1225115876
Name:STEWART, KENDAL LANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDAL
Middle Name:LANCE
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11719 BEE CAVE RD. #204
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5543
Mailing Address - Country:US
Mailing Address - Phone:512-338-9840
Mailing Address - Fax:512-338-0863
Practice Address - Street 1:11719 BEE CAVE RD. #204
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-5543
Practice Address - Country:US
Practice Address - Phone:512-338-9840
Practice Address - Fax:512-338-0863
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6632207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133151409Medicaid
TX8475B0Medicare PIN
TXF25853Medicare UPIN