MEDICARE: DR. KENNETH W VERBOS II MD

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
1	207Q00000X	Family Medicine Physician	2020031547	MO
2	207Q00000X	Family Medicine Physician	4351049233	MI
3	207Q00000X	Family Medicine Physician	4301511926	MI

General Provider Information

NPI Number	:	1992386940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH W VERBOS II MD

Provider Business Mailing Address
First Line	:	560 W MITCHELL ST STE C70
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-2275
Country	:	US
Telephone Number	:	231-487-7200
Fax Number	:	231-487-7188

Provider Business Practice Location Address
First Line	:	1890 US HIGHWAY 131 UNIT 4
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8344
Country	:	US
Telephone Number	:	231-487-2000
Fax Number	:	231-487-2039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/07/2026

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