Provider Demographics
NPI:1538268370
Name:KENT, KAREN A (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:KENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:KENT-VANGORDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6208
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 245 A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5710
Practice Address - Fax:517-364-5717
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0803303472OtherBCBS INDIVIDUAL PIN
MI4796008Medicaid
MI3342557Medicaid
MI3258542Medicaid
MI3342557Medicaid
MIOC36091012Medicare ID - Type Unspecified
MIOC36090007Medicare ID - Type Unspecified