Healthcare Provider Details

I. General information

NPI: 1871689638
Provider Name (Legal Business Name): KENT PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 WEST RIVER DR.
COMSTOCK PARK MI
49321
US

IV. Provider business mailing address

4735 WEST RIVER DR.
COMSTOCK PARK MI
49321
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-9400
  • Fax:
Mailing address:
  • Phone: 616-784-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. KATHY KUKAWSKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 616-784-9400