Shockley, Kenneth F

Shockley, Kenneth F is an sole proprietor health care provider with primary practice located at 4047 Saladin Dr Se , Grand Rapids MI 49546-6249. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Shockley, Kenneth F can be contacted via phone (616) 956-9577.

Contact Information

Primary practice address
4047 Saladin Dr Se Grand Rapids MI 49546-6249
Fax: (616) 956-5988
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 5101010606 Michigan

Profile Details

NPI number 1801854039
LBN Legal business name Shockley, Kenneth F
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 4th, 2006
Last updated Oct 17th, 2017 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801854039 NPPES
Michigan MEDICAID 3153602

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