Provider Demographics
NPI:1053394528
Name:KIDO, AKIYOSHI (MD)
Entity type:Individual
Prefix:
First Name:AKIYOSHI
Middle Name:
Last Name:KIDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:701 S HEALTH PKWY
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8352
Mailing Address - Country:US
Mailing Address - Phone:269-273-9789
Mailing Address - Fax:269-273-9611
Practice Address - Street 1:715 S HEALTH PKWY
Practice Address - Street 2:MEDICAL OFFICE BUILDING 3
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8352
Practice Address - Country:US
Practice Address - Phone:269-273-8471
Practice Address - Fax:269-273-9680
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301084601208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4670697-10Medicaid
MI700G5600080OtherBCBS GROUP-SURGICAL SERVICES
MI700G560080OtherBCBSM
MI2784044 10Medicaid
MI5209995 10Medicaid
MI5209977 10Medicaid
MIG56008 118Medicare ID - Type Unspecified
MIB45368Medicare UPIN
MI5209995 10Medicaid
MI23T015Medicare Oscar/Certification