Basic Information
| Provider Information | |||||||||
| NPI: | 1780635227 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVOA TAKARA | ||||||||
| FirstName: | KENDALL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 E MCDOWELL RD | ||||||||
| Address2: | BANNER GOOD SAMARITAN HOSPITAL, INTERNAL MEDICINE DEPT | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028392296 | ||||||||
| FaxNumber: | 6028392084 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 E MCDOWELL RD | ||||||||
| Address2: | BANNER GOOD SAMARITAN HOSPITAL, INTERNAL MEDICINE DEPT | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028392296 | ||||||||
| FaxNumber: | 6028392084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 41652 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 444164 | 05 | AZ | MEDICAID |