Healthcare Provider Details

I. General information

NPI: 1053394528
Provider Name (Legal Business Name): AKIYOSHI KIDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S HEALTH PKWY MEDICAL OFFICE BUILDING 3
THREE RIVERS MI
49093-8352
US

IV. Provider business mailing address

701 S HEALTH PKWY MEDICAL STAFF OFFICE
THREE RIVERS MI
49093-8352
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-8471
  • Fax: 269-273-9680
Mailing address:
  • Phone: 269-273-9789
  • Fax: 269-273-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301084601
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: