Provider Demographics
NPI:1760426266
Name:KAMMENZIND, RICHARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:KAMMENZIND
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 1:601 JOHN ST
Mailing Address - Street 2:SUITE M170A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-381-5060
Mailing Address - Fax:269-381-1655
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-170
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-5060
Practice Address - Fax:269-381-1655
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073526207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1103053510OtherBCBS IND PIN
MI110C910470OtherBCBS GRP PIN
MI4457836-10Medicaid
4016855OtherAETNA PIN
MI1103053510OtherBCBS IND PIN
B53979Medicare UPIN
MI4457836-10Medicaid
MI110242798Medicare PIN