Provider Demographics
NPI:1417952722
Name:HANSEN, KENDALL E (MD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:E
Last Name:HANSEN
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 1:340 THOMAS MORE PKWY
Mailing Address - Street 2:STE 260
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5117
Mailing Address - Country:US
Mailing Address - Phone:859-957-0700
Mailing Address - Fax:859-957-0703
Practice Address - Street 1:340 THOMAS MORE PKWY
Practice Address - Street 2:STE 260
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5100
Practice Address - Country:US
Practice Address - Phone:859-957-0700
Practice Address - Fax:859-957-0703
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034477207LP2900X
KY25777207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64257777Medicaid
KY64257777Medicaid
KY0666701Medicare PIN