Kenneth D Root PA-C

NPI 1053353946 - Physician Assistant - 363A00000X

NPI Details
NPI 1053353946
Gender Male
Enumeration Date 06/12/2006
Last Updated 01/18/2016
Entity Type Individual
Active Over 10 years ago
Practice Location
4100 LAKE DR SE
GRAND RAPIDS MI, 49546-8293, US
Phone (616) 391-3759
Fax (616) 391-3052
Business Location
100 MICHIGAN ST NE
MC 845
GRAND RAPIDS MI, 49503-2560, US
Phone
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Michigan
License Number 5601003447
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According to our database, Kenneth D Root PA-C NPI is 1053353946, taxonomy code is 363A00000X and license number is 5601003447, license state is located at Michigan. Kenneth D Root PA-C physically located at 4100 Lake Dr Se, Grand Rapids MI, 49546-8293. NPI Number Kenneth D Root PA-C has the Individual type.

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1053353946 NPI number is provided on an as is basis without warranty of any kind. 1053353946 is maintained by the National Plan & Provider Enumeration System. The contents of Kenneth D Root PA-C are for informational purposes only.