Provider Demographics
NPI:1356670590
Name:MAYS, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:MAYS
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 1:4299 LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106
Mailing Address - Country:US
Mailing Address - Phone:269-465-6221
Mailing Address - Fax:269-465-6299
Practice Address - Street 1:4299 LAKE STREET
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106
Practice Address - Country:US
Practice Address - Phone:269-465-6221
Practice Address - Fax:269-465-6299
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine