Individual
KENNETH F SHOCKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4047 E HILLS CT SE, GRAND RAPIDS, MI 49546-6249
(616) 956-9577
(616) 956-5988
Mailing address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
5101010606
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3153602
—
MI
Enumeration date
05/04/2006
Last updated
02/18/2026
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