Individual
KENNETH E DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1787 GRAND RIDGE CT NE, SUITE 101, GRAND RAPIDS, MI 49525
(616) 774-8131
(616) 774-8204
Mailing address
1787 GRAND RIDGE CT NE, SUITE 101, GRAND RAPIDS, MI 49525
(616) 774-8131
(616) 774-8204
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301043631
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004553974
AETNA
MI
01
—
0D17690
BLUE CROSS BLUE SHIELD
MI
05
—
2957039
—
MI
01
—
900000696
PRIORITY HEALTH
MI
Enumeration date
07/07/2006
Last updated
12/03/2008
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