# KSK MEDICAL PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043832801
- **Authorized official:** ROBYN M JONES (BUSINESS MANAGER)
- **Authorized official phone:** (517) 306-2244

## Contact information

- **Practice address:** 6300 WINTER RD, MANITOU BEACH, MI 49253-9634
- **Practice address phone:** (517) 306-2244
- **Practice address fax:** (866) 465-0269
- **Mailing address:** 6300 WINTER RD, MANITOU BEACH, MI 49253-9634
- **Mailing address phone:** (517) 306-2244
- **Mailing address fax:** (866) 465-0269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2020
- **Last updated:** 05/14/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2426860 | — | OH |