Provider Demographics
NPI:1881645042
Name:BIDDINGER, KENT RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:RICHARD
Last Name:BIDDINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:989-839-8884
Practice Address - Street 1:420 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4701
Practice Address - Country:US
Practice Address - Phone:989-839-8850
Practice Address - Fax:989-839-8884
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207X00000X204C00000X
MI4301063445207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3061270Medicaid
MIF68686Medicare UPIN
MI0568228Medicare ID - Type Unspecified