Provider Demographics
NPI:1841429339
Name:KENT, MICHAEL GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GRANT
Last Name:KENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 W CENTER STREET PROMENADE STE 400
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3960
Mailing Address - Country:US
Mailing Address - Phone:714-449-4841
Mailing Address - Fax:714-449-4956
Practice Address - Street 1:3307 RENNER DR
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3119
Practice Address - Country:US
Practice Address - Phone:707-725-9832
Practice Address - Fax:707-725-7247
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA151367208600000X
MI4301095163208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036139694OtherLICENSE