Healthcare Provider Details

I. General information

NPI: 1134179534
Provider Name (Legal Business Name): KENNETH CHARLES HILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E TINKHAM AVE.
LUDINGTON MI
49431-1464
US

IV. Provider business mailing address

907 E TINKHAM AVE
LUDINGTON MI
49431-1464
US

V. Phone/Fax

Practice location:
  • Phone: 231-843-3477
  • Fax: 231-843-9042
Mailing address:
  • Phone: 231-843-3477
  • Fax: 231-843-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberKH029627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: