Provider Demographics
NPI:1033293196
Name:KENDALL, STEPHAN D (MD)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:D
Last Name:KENDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:STE C240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1214
Mailing Address - Country:US
Mailing Address - Phone:801-262-9494
Mailing Address - Fax:801-262-0507
Practice Address - Street 1:3838 S 700 E
Practice Address - Street 2:STE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1466
Practice Address - Country:US
Practice Address - Phone:801-269-0231
Practice Address - Fax:801-269-0304
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2002-01109207RH0003X
UT8654924-1205207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU00078896Medicare PIN