Healthcare Provider Details

I. General information

NPI: 1275708307
Provider Name (Legal Business Name): KENT MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4472 DARROW RD
STOW OH
44224-1885
US

IV. Provider business mailing address

PO BOX 609
CUYAHOGA FALLS OH
44222-0609
US

V. Phone/Fax

Practice location:
  • Phone: 330-688-8789
  • Fax: 330-688-0304
Mailing address:
  • Phone: 330-923-6606
  • Fax: 330-923-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A KENT
Title or Position: DO
Credential:
Phone: 330-929-2685