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Organization
KENNETH MD PLC
Active
Organization
KENNETH MD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN JUSTUSSON (VP)
(248) 743-0396
Entity
Organization
Contact information
Practice address
4100 RIVER RD, EAST CHINA, MI 48054-2909
(810) 329-7111
Mailing address
6383 GLYNDEBOURNE DR, TROY, MI 48098-2214
(586) 960-5358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301100071
MI
Other
Enumeration date
11/16/2017
Last updated
12/27/2019
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