Provider Demographics
NPI:1134179534
Name:HILL, KENNETH CHARLES (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHARLES
Last Name:HILL
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 1:907 E TINKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1464
Mailing Address - Country:US
Mailing Address - Phone:231-843-3477
Mailing Address - Fax:231-843-9042
Practice Address - Street 1:907 E TINKHAM AVE.
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1464
Practice Address - Country:US
Practice Address - Phone:231-843-3477
Practice Address - Fax:231-843-9042
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKH029627208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27427OtherPRIORITY HEALTH
MI27427OtherPRIORITY HEALTH MEDICAID
MI4758366Medicaid