# KENNETH L GWINN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629163217
- **Authorized official:** DR. KENNETH L GWINN MD (PRESIDENT)
- **Authorized official phone:** (586) 799-1212

## Contact information

- **Practice address:** 48681 HAYES RD, SHELBY TOWNSHIP, MI 48315
- **Practice address phone:** (586) 799-1212
- **Mailing address:** 1976 MOMENTUM PL, CHICAGO, IL 60689-5319
- **Mailing address phone:** (586) 799-1212

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | KG050974 | MI | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 10/02/2008