Active NPI
Kenneth Tarter
- Military Health Care Provider
- Detroit, MI
National Provider Identifier
1255039210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military Health Care Provider
- Practice address
- 2004 E Lafayette St
Detroit, MI 48207-3949 - Phone
- (248) 508-6039
- NPI assigned
- Feb 20, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | Primary |
Addresses
Primary practice location
2004 E Lafayette St
Detroit, MI 48207-3949
Mailing address
2004 E Lafayette St
Detroit, MI 48207-3949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676851200000",
"number": "1255039210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2004 E LAFAYETTE ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482073949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2004 E LAFAYETTE ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482073949",
"telephone_number": "248-508-6039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TARTER",
"first_name": "KENNETH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-02-20",
"last_updated": "2023-02-20",
"certification_date": "2023-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Military Health Care Provider",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.