Provider Demographics
NPI:1376097766
Name:STORTZ, KENDALL ANN
Entity Type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:ANN
Last Name:STORTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KENDALL
Other - Middle Name:ANN
Other - Last Name:ALIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:5748 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9642
Mailing Address - Country:US
Mailing Address - Phone:248-709-5391
Mailing Address - Fax:
Practice Address - Street 1:5748 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438-9642
Practice Address - Country:US
Practice Address - Phone:248-709-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other