Healthcare Provider Details
I. General information
NPI: 1174511125
Provider Name (Legal Business Name): KENNETH E. VOBACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 10/12/2005
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
110 EAST THIRD STREET
DAVISON MI
48423
US
IV. Provider business mailing address
110 EAST THIRD STREET
DAVISON MI
48423
US
V. Phone/Fax
- Phone: 810-412-5437
- Fax: 810-412-5448
- Phone: 810-412-5437
- Fax: 810-412-5448
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 4301075399 |
| License Number State | MI |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 253067 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | HEALTH ADVANTAGE NETWORK |
| # 2 | |
| Identifier | 253067 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | MCLAREN HEALTH PLAN |
| # 3 | |
| Identifier | 350D410030 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | BLUE CARE NETWORK |
| # 4 | |
| Identifier | 4206451 |
| Identifier Type | MEDICAID |
| Identifier State | MI |
| Identifier Issuer | |
| # 5 | |
| Identifier | 350D410030 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | BLUE CROSS BLUE SHIELD |
| # 6 | |
| Identifier | F78643 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | HEATLH NET FEDERAL SERV |
| # 7 | |
| Identifier | 3502505081 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | BLUE CROSS BLUE SHIELD |
| # 8 | |
| Identifier | 6824734009 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | CIGNA |
| # 9 | |
| Identifier | F78643 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | HEALTH ALLIANCE PLAN |
| # 10 | |
| Identifier | 370018374 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | METRAHEALTH |
| # 11 | |
| Identifier | 4475609 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | AETNA |
| # 12 | |
| Identifier | C7478 |
| Identifier Type | OTHER |
| Identifier State | MI |
| Identifier Issuer | MCARE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
