Provider Demographics
NPI:1710041991
Name:KENDALL MEDICAL LABORATORY, INC
Entity Type:Organization
Organization Name:KENDALL MEDICAL LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-442-0800
Mailing Address - Street 1:2500 S DOUGLAS RD STE A
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6104
Mailing Address - Country:US
Mailing Address - Phone:305-442-0800
Mailing Address - Fax:305-442-0812
Practice Address - Street 1:2500 S DOUGLAS RD STE A
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6104
Practice Address - Country:US
Practice Address - Phone:305-442-0800
Practice Address - Fax:305-442-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306720OtherMEDICARE OUTSIDE FLORIDA
FLL8495Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLL8495Medicare UPIN