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Individual

KENNETH J EASTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1111 LEFFINGWELL NE, STE 100, GRAND RAPIDS, MI 49525
(616) 459-7101
(616) 954-6483
Mailing address
1111 LEFFINGWELL AVE NE, STE 100, GRAND RAPIDS, MI 49525
(616) 459-7101
(616) 954-6483

Taxonomy

Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
4301051829
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4763007
TX
01
P00240358
RR MEDICARE
Enumeration date
10/10/2005
Last updated
02/04/2013
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