Provider Demographics
NPI:1063458149
Name:KINGSBURY, JOSEPH ALLEN (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALLEN
Last Name:KINGSBURY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8069
Mailing Address - Country:US
Mailing Address - Phone:810-606-7190
Mailing Address - Fax:810-606-7186
Practice Address - Street 1:1620 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8069
Practice Address - Country:US
Practice Address - Phone:810-606-7190
Practice Address - Fax:810-606-7186
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007780208600000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1652530285OtherBLUE CROSS BLUE SHIELD MI
MI2760703OtherMOLINA HEATLHCARE
MICIGNAOtherCIGNA
MI1003847OtherMCLAREN HEALTH ADVANTAGE
MI382626196OtherTRICARE HEALTHNET
MI160B511630OtherBLUE CARE NETWORK
MI382626196OtherPPOM
MI5253028OtherTRAVELERS
MIC2896OtherMCARE
MIJK007780OtherBLUE CARE NETWORK
MIE26094OtherHEALH ALLIANCE PLAN
MI0230285OtherHEALTHPLUS OF MI
MA4073348OtherAETNA
MI2760703Medicaid
MI160B511630OtherBLUE CARE NETWORK
MI2760703Medicaid