Individual
KENNETH P WALWORTH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
721 N SHIAWASSEE ST STE 201, OWOSSO, MI 48867-1632
(989) 725-8124
(989) 723-1205
Mailing address
1210 W SAGINAW ST, LANSING, MI 48915-1927
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007136
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881096196
—
MI
Enumeration date
09/17/2014
Last updated
04/23/2024
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