Provider Demographics
NPI:1811090103
Name:ADNAN, KENDRICK MCDONALD (MD)
Entity type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:MCDONALD
Last Name:ADNAN
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:PO BOX 842578
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-2578
Mailing Address - Country:US
Mailing Address - Phone:970-926-6350
Mailing Address - Fax:970-926-6348
Practice Address - Street 1:50 BUCK CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-5428
Practice Address - Country:US
Practice Address - Phone:970-926-6340
Practice Address - Fax:970-926-6348
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32659207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1326594Medicaid
F70941Medicare UPIN
CO397318Medicare ID - Type UnspecifiedBRECKENRIDGE MED CTR