| Kenneth Forrester, CRNA | |
|
14700 Lake Shore Dr, Charlevoix, MI 49720-1931 | |
| (231) 547-4024 | |
| (231) 547-8088 |
| Full Name | Kenneth Forrester |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 14700 Lake Shore Dr, Charlevoix, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780772459 | NPI | - | NPPES |
| 3307404 | Medicaid | MI | |
| KF134116 | Other | MI | BLUE SHIELD LICENSE NUMBE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 4704134116 (Michigan) | Primary |
| Entity Name | Mackinac Straits Health System Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659536035 PECOS PAC ID: 1456420876 Enrollment ID: O20080930000157 |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth Forrester, CRNA 14700 Lake Shore Dr, Charlevoix, MI 49720-1931 Ph: (231) 547-4024 | Kenneth Forrester, CRNA 14700 Lake Shore Dr, Charlevoix, MI 49720-1931 Ph: (231) 547-4024 |
Michael C Macmillan, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 12375 Indian Place Dr, Charlevoix, MI 49720 Phone: 231-547-2496 Fax: 231-547-2823 | |
Michael Johnson, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 14700 Lake Shore Dr, Charlevoix, MI 49720 Phone: 231-547-4024 Fax: 231-547-8088 | |
Mark Leroy Vanderweide, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 14700 Lake Shore Dr, Charlevoix, MI 49720 Phone: 231-547-4024 | |
Jennifer L Simons, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 14700 Lake Shore Dr, Charlevoix, MI 49720 Phone: 231-547-4024 | |
Mel Choponis, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 14700 Lake Shore Dr, Charlevoix, MI 49720 Phone: 231-547-4024 Fax: 231-547-8088 | |
Madeline Jeakle Nemes, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 14700 Lake Shore Dr, Charlevoix, MI 49720 Phone: 231-547-4024 |