Provider Demographics
NPI:1386651487
Name:B KENT MAUPIN MD PC
Entity Type:Organization
Organization Name:B KENT MAUPIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MAUPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-954-0094
Mailing Address - Street 1:1001 MEDICAL PARK DR SE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3610
Mailing Address - Country:US
Mailing Address - Phone:616-954-0094
Mailing Address - Fax:616-954-9871
Practice Address - Street 1:1001 MEDICAL PARK DR SE
Practice Address - Street 2:SUITE 211
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3610
Practice Address - Country:US
Practice Address - Phone:616-954-0094
Practice Address - Fax:616-954-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043303207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1194783936OtherINDIVIDUAL NPI
MI2004100952OtherBCBSM
MI3152810Medicaid
MI2004100952OtherBCBSM
MI1194783936OtherINDIVIDUAL NPI
MI3152810Medicaid