Healthcare Provider Details

I. General information

NPI: 1215934385
Provider Name (Legal Business Name): MICHAEL KAMENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802
US

IV. Provider business mailing address

308 STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802
US

V. Phone/Fax

Practice location:
  • Phone: 814-863-6747
  • Fax: 814-863-8464
Mailing address:
  • Phone: 814-863-6747
  • Fax: 814-863-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05015361
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: