Healthcare Provider Details

I. General information

NPI: 1750503280
Provider Name (Legal Business Name): KENDRA DEE ATKINSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN NE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

6673 VANTAGE DR
CALEDONIA MI
49316
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-1774
  • Fax:
Mailing address:
  • Phone: 676-871-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301088228
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: