Provider Demographics
NPI:1174511125
Name:VOBACH, KENNETH E (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:VOBACH
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 1:110 EAST THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423
Mailing Address - Country:US
Mailing Address - Phone:810-412-5437
Mailing Address - Fax:810-412-5448
Practice Address - Street 1:110 EAST THIRD STREET
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423
Practice Address - Country:US
Practice Address - Phone:810-412-5437
Practice Address - Fax:810-412-5448
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI253067OtherHEALTH ADVANTAGE NETWORK
MI253067OtherMCLAREN HEALTH PLAN
MI350D410030OtherBLUE CARE NETWORK
MI4206451Medicaid
MI350D410030OtherBLUE CROSS BLUE SHIELD
MIF78643OtherHEATLH NET FEDERAL SERV
MI3502505081OtherBLUE CROSS BLUE SHIELD
MI6824734009OtherCIGNA
MIF78643OtherHEALTH ALLIANCE PLAN
MA370018374OtherMETRAHEALTH
MI4475609OtherAETNA
MIC7478OtherMCARE
MI4206451Medicaid
MI350D410030OtherBLUE CROSS BLUE SHIELD