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General NPI Number Information
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NPI Number | 1063458149
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Entity Type | Individual
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Provider Name | JOSEPH ALLEN KINGSBURY D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 1620 GENESYS PKWY
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City | GRAND BLANC
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State | MI
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Zip | 48439-8069
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Country | US
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Telephone | 810-606-7190
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Fax | 810-606-7186
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Provider Business Mailing Address
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Address Line | 1620 GENESYS PKWY
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City | GRAND BLANC
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State | MI
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Zip | 48439-8069
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Country | US
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Telephone | 810-606-7190
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Fax | 810-606-7186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101007780
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5101007780
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License Number State | MI
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