Provider Demographics
NPI:1780635227
Name:NOVOA TAKARA, KENDALL L (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:L
Last Name:NOVOA TAKARA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1111 E MCDOWELL RD
Mailing Address - Street 2:BANNER GOOD SAMARITAN HOSPITAL, INTERNAL MEDICINE DEPT
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2612
Mailing Address - Country:US
Mailing Address - Phone:602-839-2296
Mailing Address - Fax:602-839-2084
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:BANNER GOOD SAMARITAN HOSPITAL, INTERNAL MEDICINE DEPT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-839-2296
Practice Address - Fax:602-839-2084
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-04-13
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Provider Licenses
StateLicense IDTaxonomies
AZ41652208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ444164Medicaid
AZZ133633Medicare PIN
AZZ131309Medicare PIN