Provider Demographics
NPI:1720207145
Name:KENDIS, DANIEL ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROGER
Last Name:KENDIS
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 1:23788 E GROVELAND RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1205
Mailing Address - Country:US
Mailing Address - Phone:216-291-5143
Mailing Address - Fax:
Practice Address - Street 1:23788 E GROVELAND RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1205
Practice Address - Country:US
Practice Address - Phone:216-403-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0404753Medicaid
OHKE0463232Medicare Oscar/Certification
OHA78718Medicare UPIN