Provider Demographics
NPI:1326533811
Name:KENDALL, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY STE 455
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1265
Mailing Address - Country:US
Mailing Address - Phone:248-465-4847
Mailing Address - Fax:248-465-4063
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 455
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1265
Practice Address - Country:US
Practice Address - Phone:248-465-4847
Practice Address - Fax:248-465-4063
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301114966208000000X
MI4301504863208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics