Provider Demographics
NPI:1982113452
Name:POCHMARA, KENDYL NOEL (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDYL
Middle Name:NOEL
Last Name:POCHMARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDYL
Other - Middle Name:NOEL
Other - Last Name:DIEDERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:49397 APPALOOSA DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4730
Mailing Address - Country:US
Mailing Address - Phone:586-260-5919
Mailing Address - Fax:
Practice Address - Street 1:43455 SCHOENHERR RD STE 2
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1972
Practice Address - Country:US
Practice Address - Phone:586-726-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant