Provider Demographics
NPI:1811227390
Name:FENDRICH, LAUREL D (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:D
Last Name:FENDRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAUREL
Other - Middle Name:D
Other - Last Name:HIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10010 KENNERLY RD FL 4
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2106
Mailing Address - Country:US
Mailing Address - Phone:314-525-6072
Mailing Address - Fax:
Practice Address - Street 1:10010 KENNERLY RD FL 4
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-525-6072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013022992207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology