Provider Demographics
NPI:1588833123
Name:KENT R. BIDDINGER, M.D.
Entity Type:Organization
Organization Name:KENT R. BIDDINGER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BIDDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-839-8850
Mailing Address - Street 1:420 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4701
Mailing Address - Country:US
Mailing Address - Phone:989-839-8850
Mailing Address - Fax:989-839-8884
Practice Address - Street 1:420 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4701
Practice Address - Country:US
Practice Address - Phone:989-839-8850
Practice Address - Fax:989-839-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKB063445332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3061270Medicaid
MIP83803OtherBCN
MI0982795OtherHEALTH PLUS
MIF68686Medicare UPIN
MI5003650001Medicare NSC