Provider Demographics
NPI:1639284284
Name:KINDER, BRENT WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:WAYNE
Last Name:KINDER
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 1:2055 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1981
Mailing Address - Country:US
Mailing Address - Phone:513-735-1701
Mailing Address - Fax:513-735-8995
Practice Address - Street 1:2055 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1981
Practice Address - Country:US
Practice Address - Phone:513-735-1701
Practice Address - Fax:513-735-8995
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78352207RC0200X, 207RP1001X, 207R00000X
OH35.090338207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2784670Medicaid
KY7100025860Medicaid
IN200887300Medicaid
IN200887300Medicaid