Individual
KEVIN LAVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1116 W GANSON ST, JACKSON, MI 49202-4240
(517) 782-9436
(517) 782-5166
Mailing address
850 W NORTH ST STE 104, JACKSON, MI 49202-3196
(877) 852-8463
(517) 817-0144
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301055930
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180019354
RAILROAD MEDICARE
—
01
—
180C846310
BCBSM
MI
01
—
180F373640
BCBSM
MI
01
—
180H149970
BCBSM
MI
05
—
3037800
—
MI
05
—
3222862
—
MI
05
—
3287606
—
MI
Enumeration date
06/14/2005
Last updated
09/20/2018
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