Provider Demographics
NPI:1356343214
Name:KENDALL, MICHAEL WELT (DPM PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WELT
Last Name:KENDALL
Suffix:
Gender:M
Credentials:DPM PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1607
Mailing Address - Country:US
Mailing Address - Phone:806-358-0448
Mailing Address - Fax:806-358-4338
Practice Address - Street 1:702 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1607
Practice Address - Country:US
Practice Address - Phone:806-358-0448
Practice Address - Fax:806-358-4338
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0890213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0897191-01Medicaid
TX00FJ65Medicare ID - Type Unspecified
TX4603430001Medicare NSC
TX0897191-01Medicaid