Provider Demographics
NPI:1396751087
Name:KENNETH ISRAEL M.D. P.C.
Entity type:Organization
Organization Name:KENNETH ISRAEL M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-851-1159
Mailing Address - Street 1:26111 W 14 MILE RD
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1168
Mailing Address - Country:US
Mailing Address - Phone:248-851-1159
Mailing Address - Fax:248-851-2478
Practice Address - Street 1:26111 W 14 MILE RD
Practice Address - Street 2:SUITE LL2
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1168
Practice Address - Country:US
Practice Address - Phone:248-851-1159
Practice Address - Fax:248-851-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0204992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P59480Medicare PIN