Individual
KENTON LEE WATERBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3370 E JOLLY RD, LANSING, MI 48910-8552
(517) 487-3717
(517) 487-3472
Mailing address
3370 E JOLLY RD, LANSING, MI 48910-8552
(517) 487-3717
(517) 487-3472
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
KW008742
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912972
—
MI
Enumeration date
09/22/2005
Last updated
08/12/2011
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