Provider Demographics
NPI:1851359178
Name:MARKIEWICZ, KENNETH HARRY (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HARRY
Last Name:MARKIEWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S 3RD ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-5115
Mailing Address - Country:US
Mailing Address - Phone:989-584-0932
Mailing Address - Fax:989-584-0918
Practice Address - Street 1:102 S 3RD ST
Practice Address - Street 2:STE 200
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-5115
Practice Address - Country:US
Practice Address - Phone:989-584-0932
Practice Address - Fax:989-584-0918
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007662207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0454111024OtherBCBSM
MI1642877Medicaid
MIMI1093001Medicare PIN
MI1642877Medicaid