Healthcare Provider Details

I. General information

NPI: 1427099886
Provider Name (Legal Business Name): JOSEPH A. KINGSBURY, D.O.,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 GENESYS PKWY
GRAND BLANC MI
48439-2560
US

IV. Provider business mailing address

1620 GENESYS PKWY
GRAND BLANC MI
48439-2560
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-7190
  • Fax: 810-606-7186
Mailing address:
  • Phone: 810-606-7190
  • Fax: 810-606-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ALLEN KINGSBURY
Title or Position: PRESIDENT
Credential: D. O.
Phone: 810-606-7190