Provider Demographics
NPI:1427099886
Name:JOSEPH A. KINGSBURY, D.O.,PC
Entity type:Organization
Organization Name:JOSEPH A. KINGSBURY, D.O.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KINGSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:810-606-7190
Mailing Address - Street 1:1620 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2560
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:48439-2560
Practice Address - Country:US
Practice Address - Phone:810-606-7190
Practice Address - Fax:810-606-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1761231OtherCIGNA
4073348OtherAETNA
MI160B511630OtherBLUE CROSS BLUE SHIELD MI
MI1652511805OtherBCBS
MI1652530285OtherBCBS
MI2760703OtherMOLINA
MI4928770Medicaid
MI01003097OtherHEALTHPLUS OF MI
MI0230285OtherHEALTH PLUS OF MICHIGAN
160B511630OtherBLUE CARE NETWORK
MI2760703Medicaid
MIC2896OtherMCARE
MIE26094OtherHEALTH ALLIANCE PLAN
MIC2896OtherMCARE
MII60137Medicare UPIN
MI1652530285OtherBCBS
MI2760703OtherMOLINA
4073348OtherAETNA
MIC2896OtherMCARE
MIP10950003Medicare ID - Type Unspecified