Provider Demographics
NPI:1942269741
Name:SCHENDEL, KEVIN DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DENNIS
Last Name:SCHENDEL
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2479
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7624
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041754A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100097680Medicaid
INSC17843001Medicaid
IN10825893OtherCAQH NUMBER
IN000000192071OtherANTHEM PROVIDER NUMBER
IN9397450OtherPHCS PID NUMBER
IN100097680Medicaid
IN000000192071OtherANTHEM PROVIDER NUMBER
INF46853Medicare UPIN