KSK Medical PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

KSK MEDICAL PLLC

Practice address

6300 Winter Rd
Manitou Beach, MI 49253-9634

Phone

(517) 306-2244

Fax

(866) 465-0269

NPI assigned

May 14, 2020

Last updated

May 14, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robyn M Jones

Title

Business Manager

Phone

(517) 306-2244

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589414400000",
    "number": "1043832801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 WINTER RD",
            "city": "MANITOU BEACH",
            "state": "MI",
            "postal_code": "492539634",
            "telephone_number": "517-306-2244",
            "fax_number": "866-465-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 WINTER RD",
            "city": "MANITOU BEACH",
            "state": "MI",
            "postal_code": "492539634",
            "telephone_number": "517-306-2244",
            "fax_number": "866-465-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSK MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-14",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "517-306-2244"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2426860",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Polly Lou Chesser, RN
• Bailey Feekings, ATC
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• Christina Jones
• Lakeview Family Counseling Center LLC
• Aileen Marie Myers Maloney, R.N.
• Kelly R Niezurawski, NP
• Kristina Powell
• Tonya R Snyr, RN

• General Practice Physician in Manitou Beach, MI
• Providers in Manitou Beach, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.