MEDICARE: DR. KENNETH A PARADA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	4301050538	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0801600151	OTHER	MI	INDIVIDUAL BLUE CROSS

General Provider Information

NPI Number	:	1588697718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A PARADA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 419
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-0419
Country	:	US
Telephone Number	:	231-627-5601
Fax Number	:	231-627-1471

Provider Business Practice Location Address
First Line	:	748 S MAIN ST
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2220
Country	:	US
Telephone Number	:	231-627-5601
Fax Number	:	231-627-1471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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