Provider Demographics
NPI:1376517441
Name:POST, KENNETH WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:WAYNE
Last Name:POST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4069 LAKE DR SE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8816
Mailing Address - Country:US
Mailing Address - Phone:616-267-7601
Mailing Address - Fax:616-267-7200
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:MC 845
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-454-9960
Practice Address - Fax:616-454-9227
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-01-23
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Provider Licenses
StateLicense IDTaxonomies
MI4301043909208600000X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B47525Medicare UPIN