Provider Demographics
NPI:1730185554
Name:MORRISON, KENNETH M (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:MORRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 E JOLLY RD
Mailing Address - Street 2:STE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8595
Mailing Address - Country:US
Mailing Address - Phone:517-394-3200
Mailing Address - Fax:517-394-4250
Practice Address - Street 1:3394 E JOLLY RD
Practice Address - Street 2:STE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8595
Practice Address - Country:US
Practice Address - Phone:517-394-3200
Practice Address - Fax:517-394-4250
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045099207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKM045099OtherBLUE CROSS/BLUE SHHIELD
MIP52714OtherBCN
MI09-00008OtherPHP
MI4385450Medicaid
MIF00542Medicare UPIN
MI09-00008OtherPHP