Provider Demographics
NPI:1821129644
Name:KENNETH C. HILL, M. D., P. C.
Entity Type:Organization
Organization Name:KENNETH C. HILL, M. D., P. C.
Other - Org Name:PEDIATRIC & ADOLESCENT MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:231-843-3477
Mailing Address - Street 1:907 E TINKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431
Mailing Address - Country:US
Mailing Address - Phone:231-843-3477
Mailing Address - Fax:231-843-9042
Practice Address - Street 1:907 E TINKHAM AVE.
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431
Practice Address - Country:US
Practice Address - Phone:231-843-3477
Practice Address - Fax:231-843-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011009208000000X
MI4301029627208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27427OtherPRIORITY HEALTH
MI4770398Medicaid
MI4758366Medicaid
MI4770398Medicaid
MI=========051OtherCOMMUNITY CHOICE HILL