Provider Demographics
NPI:1053490813
Name:MUSKEGON COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MUSKEGON COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:231-724-6246
Mailing Address - Street 1:209 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3406
Mailing Address - Country:US
Mailing Address - Phone:231-724-6246
Mailing Address - Fax:231-724-6674
Practice Address - Street 1:209 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3406
Practice Address - Country:US
Practice Address - Phone:231-724-6246
Practice Address - Fax:231-724-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1930710Medicaid
MI99198OtherBCCCP