Provider Demographics
NPI:1104844919
Name:KENDALL, COREY B (MD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:B
Last Name:KENDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8450 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1381
Mailing Address - Country:US
Mailing Address - Phone:317-802-2000
Mailing Address - Fax:317-802-2170
Practice Address - Street 1:9070 E 56TH ST STE 400
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7074
Practice Address - Country:US
Practice Address - Phone:317-268-3600
Practice Address - Fax:317-268-3695
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01062840A207X00000X, 207XX0005X, 207XX0005X
IN01062840207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200871610Medicaid
IN037170K1Medicare PIN