Provider Demographics
NPI:1386625606
Name:AGREST, KEVIN A (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:AGREST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:21647 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2795
Mailing Address - Country:US
Mailing Address - Phone:586-757-4200
Mailing Address - Fax:586-757-8332
Practice Address - Street 1:21647 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2795
Practice Address - Country:US
Practice Address - Phone:586-757-4200
Practice Address - Fax:586-757-8332
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101014983OtherSTATE LICENSE NUMBER
MI0858214695OtherBCBSM
MI0858214695OtherBCBSM