Individual
DR. KENYON S KENDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
750 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-6049
(616) 949-2600
(616) 365-2076
Mailing address
750 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-6049
(616) 949-2600
(616) 365-2076
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
5101007594
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180007179
MEDICARE RR
MI
01
—
180D148331
BCBS
MI
05
—
1934460
—
MI
Enumeration date
06/14/2005
Last updated
06/05/2008
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