Individual
DR. DOMINIC JAMES KIOMENTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8950 PROFESSIONAL DR, CADILLAC, MI 49601-8599
(231) 775-2493
(231) 775-2570
Mailing address
8950 PROFESSIONAL DR, CADILLAC, MI 49601-8599
(231) 775-2493
(231) 779-7701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301086808
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080H310080
BC BILLING NUMBER
MI
01
—
141754
PREF CHOICE BILLING
MI
01
—
4798746
MOLINA BILLING NUMBER
MI
05
—
4798746
—
MI
01
—
DK086808
STATE LICENSE NUMBER
MI
Enumeration date
01/19/2006
Last updated
03/05/2025
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