Individual
DR. KEVIN A AGREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
21647 RYAN RD, WARREN, MI 48091-2795
(586) 757-4200
(586) 757-8332
Mailing address
21647 RYAN RD, WARREN, MI 48091-2795
(586) 757-4200
(586) 757-8332
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101014983
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0858214695
BCBSM
MI
01
—
5101014983
STATE LICENSE NUMBER
MI
Enumeration date
11/14/2005
Last updated
08/16/2012
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