Provider Demographics
NPI:1811951247
Name:KENDALL MEDICAL CENTER, INC
Entity type:Organization
Organization Name:KENDALL MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWANINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-0808
Mailing Address - Street 1:11120 N KENDALL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1473
Mailing Address - Country:US
Mailing Address - Phone:305-279-0808
Mailing Address - Fax:305-271-4916
Practice Address - Street 1:11120 N KENDALL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1473
Practice Address - Country:US
Practice Address - Phone:305-279-0808
Practice Address - Fax:305-271-4916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENDALL MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2009-06-24
Deactivation Date:2009-05-07
Deactivation Code:
Reactivation Date:2009-06-24
Provider Licenses
StateLicense IDTaxonomies
FLOS 8030207Q00000X
FLOS0001730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254263300Medicaid
FL261046900Medicaid
DCE32033Medicare UPIN
FL261046900Medicaid
FLH76459Medicare UPIN
FL254263300Medicaid