Healthcare Provider Details

I. General information

NPI: 1780326926
Provider Name (Legal Business Name): MICHAEL HUGH KENNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 CENTRAL PARK WAY NE APT 202
GRAND RAPIDS MI
49505-3482
US

IV. Provider business mailing address

2833 CENTRAL PARK WAY NE APT 202
GRAND RAPIDS MI
49505-3482
US

V. Phone/Fax

Practice location:
  • Phone: 989-513-0166
  • Fax:
Mailing address:
  • Phone: 989-513-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351049724
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: