Basic Information
| Provider Information | |||||||||
| NPI: | 1811090103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADNAN | ||||||||
| FirstName: | KENDRICK | ||||||||
| MiddleName: | MCDONALD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 MAIN ST # C301 | ||||||||
| Address2: | |||||||||
| City: | EDWARDS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816328109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705693600 | ||||||||
| FaxNumber: | 9705693601 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 SOUTH PARK | ||||||||
| Address2: | |||||||||
| City: | BRECKENRIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704531010 | ||||||||
| FaxNumber: | 9704535407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 32659 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 32659 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1326594 | 05 | CO | MEDICAID |