Provider Demographics
NPI:1326049081
Name:KENDIS, BETSY L (MD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:L
Last Name:KENDIS
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 1:4575 STEPHENS CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3629
Mailing Address - Country:US
Mailing Address - Phone:330-499-9944
Mailing Address - Fax:330-499-3056
Practice Address - Street 1:4575 STEPHENS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3629
Practice Address - Country:US
Practice Address - Phone:330-499-9944
Practice Address - Fax:330-499-3056
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070944207RA0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2017749Medicaid
OHG58569Medicare UPIN
OH2017749Medicaid