Provider Demographics
NPI:1285648097
Name:KENDALL, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:KENDALL
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 1:135 W PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1010
Mailing Address - Country:US
Mailing Address - Phone:419-732-7800
Mailing Address - Fax:419-797-4843
Practice Address - Street 1:135 W PERRY ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1010
Practice Address - Country:US
Practice Address - Phone:419-732-7800
Practice Address - Fax:419-797-4843
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062349207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0872515Medicaid
OH4194361OtherMEDICARE PTAN
P00342604OtherRAILROAD MEDICARE
P00342604OtherRAILROAD MEDICARE
OH4194361Medicare PIN