Provider Demographics
NPI:1922094689
Name:GAHRY, KENNETH WAYNE (PA-C, MS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WAYNE
Last Name:GAHRY
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Gender:M
Credentials:PA-C, MS
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Mailing Address - Street 1:3669 CROOKS RD
Mailing Address - Street 2:STE 17
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2458
Mailing Address - Country:US
Mailing Address - Phone:248-549-1837
Mailing Address - Fax:248-549-0044
Practice Address - Street 1:5130 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1001
Practice Address - Country:US
Practice Address - Phone:248-288-9500
Practice Address - Fax:248-288-0044
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-01-04
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Provider Licenses
StateLicense IDTaxonomies
MI5601004065363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q06289Medicare UPIN
N84070001Medicare ID - Type Unspecified