Individual
KENNETH P TARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101008688
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1876123
—
MI
05
—
1876132
—
MI
01
—
300073227
RRMC
MI
01
—
310D460020
BCBS GROUP PIN
MI
01
—
3156310454
BCBS PIN #
MI
01
—
CA5318
MEDICARE RR GROUP PIN
MI
Enumeration date
06/29/2006
Last updated
01/24/2017
Update your record
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