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NPI Code Detail

MEDICARE: KENNETH DARRYL KAWA CRNA

MEDICARE: KENNETH DARRYL KAWA CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist4704127316MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2430F364420OTHERMIBCBSM

General Provider Information

NPI Number : 1902874308
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH DARRYL KAWA CRNA
Provider Business Mailing Address
First Line : 21230 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48091-2279
Country : US
Telephone Number : 586-427-1000
Fax Number :
Provider Business Practice Location Address
First Line : 21230 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48091-2279
Country : US
Telephone Number : 586-427-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 11/11/2009

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