Provider Demographics
NPI:1326036963
Name:HUGGETT, KELLY B (MD)
Entity type:Individual
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First Name:KELLY
Middle Name:B
Last Name:HUGGETT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3152 PORT SHELDON ST
Practice Address - Street 2:SUITE C
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9297
Practice Address - Country:US
Practice Address - Phone:616-669-9238
Practice Address - Fax:616-669-8296
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-02-17
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Provider Licenses
StateLicense IDTaxonomies
MI4401076470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII35302Medicare UPIN
MI4688682Medicaid