Individual
KENNETH RESHARD MASSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3507 GREEN BAY RD APT 208B, NORTH CHICAGO, IL 60064-3658
(313) 549-8403
Mailing address
3507 GREEN BAY RD APT 208B, NORTH CHICAGO, IL 60064-3658
(313) 549-8403
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MI
Other
Enumeration date
04/06/2026
Last updated
04/06/2026
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