Provider Demographics
NPI:1780657718
Name:YOUNG, KURT R (DO)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1640 FORT ST STE D
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:2070 BIDDLE AVE STE 2
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192
Practice Address - Country:US
Practice Address - Phone:734-282-2020
Practice Address - Fax:734-282-2002
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q260790OtherBCBSM
MI4459625Medicaid
MI0Q26079008Medicare ID - Type Unspecified
MI4459625Medicaid