KENTON LEE WATERBROOK (NPI# 1750377966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750377966 |
| Entity Type | Individual |
| Full Name | KENTON LEE WATERBROOK |
| Credential | DO |
| Practice Address |
3370 E Jolly Rd Lansing MI 48910-8552 |
| Practice Telephone | 5174873717 |
| Practice Fax Number | 5174873472 |
| Mailing Telephone | 5174873717 |
| Mailing Fax Number | 5174873472 |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2011-08-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | KW008742 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1912972 | 05 |
| Street Address |
3370 E JOLLY RD |
| City | LANSING |
| State | MI |
| Zip Code | 48910-8552 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356884928 | Sarah Pangle | Occupational Therapist | 3370 E Jolly Rd, Lansing, MI 48910-8552 | 2016-11-29 |
| 1396147484 | Physiotherapy Associates | Respite Care | 3370 E Jolly Rd, Lansing, MI 48910-8552 | 2014-09-19 |
| 1154660025 | Tammy Marie Fickies | Occupational Therapist | 3370 E Jolly Rd, Ste B, Lansing, MI 48910-8552 | 2013-02-12 |
| 1669727871 | Broderick Earl Peariso | Physical Therapy Assistant | 3370 E Jolly Rd, Lansing, MI 48910-8552 | 2012-07-14 |
| 1083909048 | Melissa Drake | Physical Therapist | 3370 E Jolly Rd, Suite B, Lansing, MI 48910-8552 | 2011-06-17 |
| 1548562853 | Pamela Corden | Specialist | 3370 E Jolly Rd, Ste B, Lansing, MI 48910-8552 | 2010-11-19 |
| 1700113636 | Christie Lynne Lemon | Occupational Therapist | 3370 E Jolly Rd, Lansing, MI 48910-8552 | 2009-11-13 |
| 1295981918 | Shashi Krishna Gunda | Physical Therapist | 3370 E Jolly Rd, Lansing, MI 48910-8552 | 2008-08-13 |
| 1700087384 | Michelle Renee Keever | Physical Therapy Assistant | 3370 E Jolly Rd, Suite B, Lansing, MI 48910-8552 | 2007-05-30 |
| 1174724728 | Debbie Sue Lansdell | Physical Therapy Assistant | 3370 E Jolly Rd, Suite B, Lansing, MI 48910-8552 | 2007-05-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821604562 | Wendy Lynne Hughes | Licensed Practical Nurse | 2025 S Washington Ave Suite 210 Lansing, Mi 48910, Lansing, MI 48910 | 2020-09-18 |
| 1073146908 | James Laroach | Peer Specialist | 913 W. Homes Suite 200, Lansing, MI 48910 | 2020-02-19 |
| 1487284279 | Kourtia Nicole Munson | Counselor | 2025 S Washighton Ave, Suite 210, Lansing, MI 48910 | 2020-01-21 |
| 1699248112 | Cedar Pharmacy LLC | Pharmacy | 2513 S Cedar St., Lansing, MI 48910 | 2019-01-08 |
| 1134604390 | Kazuho Kondo | Student in an Organized Health Care Education/Training Program | 3338 Beau Jardin Dr., 0812, Lansing, MI 48910 | 2018-10-03 |
| 1477036655 | Dalia Elgohary | Pharmacist | 5016 S Martin Luther King, Lansing, MI 48910 | 2018-09-13 |
| 1457856940 | Derrick Lynn Byrd | Social Worker | 4305 S. Cedar St., Lansing, MI 48910 | 2018-03-27 |
| 1326564964 | Lansing Health Supplies | Durable Medical Equipment & Medical Supplies | 3105 S Martin Luther King Blvd #320, Lansing, MI 48910 | 2017-08-15 |
| 1265957203 | Heather E Dover | Dietitian, Registered | 2510 Solomon Dr, Lansing, MI 48910 | 2017-08-10 |
| 1407307705 | Elise Evans | Occupational Therapist | 2331 East Jolly Rd, Suite B, Lansing, MI 48910 | 2016-10-21 |
| Find all providers in zip 48910 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114280898 | Matthew James Dubiel | Orthopaedic Surgery | 3394 E Jolly Rd Ste A, Lansing, MI 48910-8595 | 2012-06-19 |
| 1063672657 | Linda Marie Hughson | Orthopaedic Surgery | 3370 E Jolly, Lansing, MI 48910 | 2008-06-17 |
| 1235305673 | Mclaren Greater Lansing | Orthopaedic Surgery | 2815 S Pennyslvania, Suite 102, Lansing, MI 48910 | 2008-05-06 |
| 1548252919 | Edward Charles Sladek | Orthopaedic Surgery | 1000 N Homer St, Lansing, MI 48912-4903 | 2005-08-22 |
| 1942206768 | Brian Mccardel | Orthopaedic Surgery | 3394 E Jolly Rd, Ste A, Lansing, MI 48910-8595 | 2005-06-27 |
| 1265912851 | Meredith C Heisey Do PC | Orthopaedic Surgery | 2815 S Pennsylvania Ave, Suite 204, Lansing, MI 48910 | 2018-08-14 |
| 1538564075 | Mark L. Davis, Do PC | Orthopaedic Surgery | 1515 Lake Lansing Rd, Suite B1, Lansing, MI 48912-3753 | 2014-10-27 |
| 1699027086 | Dr. Steven L Drayer, Pllc | Orthopaedic Surgery | 1515 Lake Lansing Rd, Ste B-1, Lansing, MI 48912-3753 | 2012-10-09 |
| 1245594027 | Jeffery Martin Uitvlugt | Orthopaedic Surgery | 3394 E Jolly Rd Ste A, Lansing, MI 48910 | 2012-06-27 |
| 1164788378 | Daniel R Mesko | Orthopaedic Surgery | 2815 S Pennsylvania Ave, Suite 204, Lansing, MI 48910 | 2012-04-02 |
| Find all providers in LANSING | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.