NPIMap

Organization Active NPI

Paul Kenzie, O.D., P.C.

  • Durable Medical Equipment & Medical Supplies
  • Plymouth, MI
National Provider Identifier
1760523336
Registry record updated Dec 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
4901002510 Issued in MI
Legal business name
PAUL KENZIE, O.D., P.C.
Practice address
108 N Main St
Plymouth, MI 48170-1236
Phone
(734) 453-8450
Fax
(734) 453-6347
NPI assigned
Feb 8, 2007
Last updated
Dec 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2008

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

Authorized official

Name
Mrs. Debra Jean Fitzgibbon
Title
Office Manager
Phone
(734) 453-8450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 4901002510 MI Primary

Addresses

Primary practice location

108 N Main St
Plymouth, MI 48170-1236

Mailing address

108 N Main St
Plymouth, MI 48170-1236
Phone (734) 453-8450

National Provider Directory

National Provider Directory

Locations

108 N Main St
Plymouth, MI 48170
Phone (734) 453-8450

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229904000000",
    "number": "1760523336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N MAIN ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701236",
            "telephone_number": "734-453-8450",
            "fax_number": "734-453-6347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 N MAIN ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701236",
            "telephone_number": "734-453-8450",
            "fax_number": "734-453-6347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL KENZIE, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2008-12-22",
        "status": "A",
        "authorized_official_last_name": "FITZGIBBON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "734-453-8450",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "4901002510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2008; 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.