Healthcare Provider Details

I. General information

NPI: 1821129644
Provider Name (Legal Business Name): KENNETH C. HILL, M. D., P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E TINKHAM AVE.
LUDINGTON MI
49431
US

IV. Provider business mailing address

907 E TINKHAM AVE
LUDINGTON MI
49431
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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101011009
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301029627
License Number StateMI

VIII. Authorized Official

Name: DR. KENNETH C HILL
Title or Position: MEMBER
Credential: M. D.
Phone: 231-843-3477