Provider Demographics
NPI:1598702201
Name:SCHWARTZ, KENDRA LEE (MD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEE
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-359-8073
Mailing Address - Fax:248-359-8036
Practice Address - Street 1:26400 W 12 MILE RD
Practice Address - Street 2:STE 111
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1771
Practice Address - Country:US
Practice Address - Phone:248-359-8073
Practice Address - Fax:248-359-8036
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630313Medicare PIN