Provider Demographics
NPI:1194718023
Name:KENDALL, TODD J (MD)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:J
Last Name:KENDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 MEMORIAL HOSPITAL DR STE 1D
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1180
Mailing Address - Country:US
Mailing Address - Phone:251-662-9760
Mailing Address - Fax:251-272-1979
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B 218
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6776
Practice Address - Country:US
Practice Address - Phone:251-633-3617
Practice Address - Fax:251-633-9330
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00022814207ZP0102X
MS18733207ZP0102X
ALMD.22814207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051551979Medicaid
MS00126675Medicaid
G96206Medicare UPIN
MS00126675Medicaid
AL051551979Medicare ID - Type Unspecified