Provider Demographics
NPI:1932303484
Name:BARK, KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:BARK
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 1:595 BARCLAY CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5802
Mailing Address - Country:US
Mailing Address - Phone:248-852-8020
Mailing Address - Fax:248-852-8081
Practice Address - Street 1:595 BARCLAY CIR
Practice Address - Street 2:SUITE A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5802
Practice Address - Country:US
Practice Address - Phone:248-852-8020
Practice Address - Fax:248-852-8081
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096256208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery