Provider Demographics
NPI:1598772089
Name:KENDALL, MELISSA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:DEMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:716 W 800 N STE 300
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-6300
Mailing Address - Country:US
Mailing Address - Phone:801-224-0421
Mailing Address - Fax:801-224-0821
Practice Address - Street 1:716 W 800 N STE 300
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6300
Practice Address - Country:US
Practice Address - Phone:801-224-0421
Practice Address - Fax:801-224-0821
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98-357595-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD2446Medicaid
UTD2446Medicaid