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Individual

JEREMY S KENDRA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1000 HARRINGTON ST, MOUNT CLEMENS, MI 48043-2920
(586) 493-8098
(586) 493-8706
Mailing address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 551-0424
(248) 551-5426

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301084369
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
310E011330
BCBS MI GROUP PIN
MI
01
CI8050
MEDICARE RR GROUP PIN
MI
Enumeration date
05/11/2007
Last updated
06/01/2010
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