Kenneth J Fawcett Jr., MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301054239 Issued in MI

Practice address

3271 Clear Vista CT NE
Grand Rapids, MI 49525-9477

Phone

(616) 391-7800

Fax

(616) 391-7838

NPI assigned

Jun 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409184000000",
    "number": "1972507788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-7800",
            "fax_number": "616-391-7838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3271 CLEAR VISTA CT NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259477",
            "telephone_number": "616-391-7800",
            "fax_number": "616-391-7838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAWCETT",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2014-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301054239",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301054239",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "0N10270003",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4199704",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth A. Fausone, MS,CCC,SLP
• Linda Wetherbee Faust, LMSW
• Sage Faustino-Ramirez
• Kimberly Favela
• Hannah Rose Fawcett, PA-C
• Lauren Nicole Fay, PHARMD
• Anna Grace Faybrick, PA
• Azra Fazil-Jamal, OD
• Andrew Steven Fazzola
• Raymond Fecteau, BEHAVIOR TECHNICIAN

• Internal Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; 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.