Provider Demographics
NPI:1316927106
Name:KIOMENTO, HELEN M (MD)
Entity type:Individual
Prefix:DR
First Name:HELEN
Middle Name:M
Last Name:KIOMENTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:827 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2015
Mailing Address - Country:US
Mailing Address - Phone:231-775-9741
Mailing Address - Fax:231-775-9333
Practice Address - Street 1:827 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2015
Practice Address - Country:US
Practice Address - Phone:231-775-9741
Practice Address - Fax:231-775-9333
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI238635Medicare Oscar/Certification
MI0H36303010Medicare PIN