Provider Demographics
NPI:1225476013
Name:GENO, KENDAL LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:KENDAL
Middle Name:LEWIS
Last Name:GENO
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 1:125 E LOCKLING AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628
Mailing Address - Country:US
Mailing Address - Phone:660-258-8237
Mailing Address - Fax:
Practice Address - Street 1:125 E LOCKLING ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-2367
Practice Address - Country:US
Practice Address - Phone:660-258-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013017659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine