Provider Demographics
NPI:1639885874
Name:KENDRA LEVI DO, LLC
Entity Type:Organization
Organization Name:KENDRA LEVI DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-919-5068
Mailing Address - Street 1:139 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1108
Mailing Address - Country:US
Mailing Address - Phone:772-919-5068
Mailing Address - Fax:
Practice Address - Street 1:502 BULLOCKS POINT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-3504
Practice Address - Country:US
Practice Address - Phone:772-919-5068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty