Provider Demographics
NPI:1003850686
Name:KING, JEFFREY CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST STE M-206C
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5359
Mailing Address - Country:US
Mailing Address - Phone:855-618-2676
Mailing Address - Fax:269-488-8284
Practice Address - Street 1:601 JOHN ST STE M-206C
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5359
Practice Address - Country:US
Practice Address - Phone:855-618-2676
Practice Address - Fax:269-488-8284
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059500207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003850686Medicaid
110174OtherGREAT LAKES HLTH PLN
MI4290938-10Medicaid
MI200C910540OtherBCBS GRP PIN
MI2003905471OtherBCBS IND PIN
5315705OtherAETNA PIN
MI4290938-10Medicaid
MI200C910540OtherBCBS GRP PIN
110174OtherGREAT LAKES HLTH PLN
MI1003850686Medicaid
MI200040856Medicare PIN