Provider Demographics
NPI:1871689638
Name:KENT PEDIATRICS, PC
Entity Type:Organization
Organization Name:KENT PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-784-9400
Mailing Address - Street 1:4735 WEST RIVER DR.
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321
Mailing Address - Country:US
Mailing Address - Phone:616-784-9400
Mailing Address - Fax:
Practice Address - Street 1:4735 WEST RIVER DR.
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321
Practice Address - Country:US
Practice Address - Phone:616-784-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty