Provider Demographics
NPI:1053533885
Name:KACOS JR, FREDERICK
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:KACOS JR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8852 JE NE BE DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8313
Mailing Address - Country:US
Mailing Address - Phone:616-874-7022
Mailing Address - Fax:
Practice Address - Street 1:330 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3631
Practice Address - Country:US
Practice Address - Phone:616-459-7111
Practice Address - Fax:616-459-8277
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501001548237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist