Individual
KENNETH D ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1179 E PARIS AVE SE STE 150, GRAND RAPIDS, MI 49546-8373
(616) 455-9450
Mailing address
1179 E PARIS AVE SE STE 150, GRAND RAPIDS, MI 49546-8373
(616) 455-9450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003447
MI
Other
Enumeration date
06/12/2006
Last updated
05/14/2026
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