Fawcett, Kenneth J
Fawcett, Kenneth J is an individual health care provider with primary practice located at 3271 Clear Vista Ct Ne , Grand Rapids MI 49525-9477. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Fawcett, Kenneth J can be contacted via phone (616) 391-7800.Contact Information
Primary practice address
3271 Clear Vista Ct Ne
Grand Rapids MI 49525-9477
Phone: (616) 391-7800
Fax: (616) 391-7838
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 4301054239 | Michigan |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 4301054239 | Michigan |
Profile Details
| NPI number | 1972507788 |
|---|---|
| LBN Legal business name | Fawcett, Kenneth J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 9th, 2005 |
| Last updated | Aug 28th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972507788 | NPPES |
| Michigan | Other | 0N10270003 | MEDICARE GROUP |
| Michigan | MEDICAID | 4199704 | MEDICARE GROUP |
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