# KENNETH MD PLC

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

## Provider details

- **NPI number:** 1831603596
- **Authorized official:** LYNN JUSTUSSON (VP)
- **Authorized official phone:** (248) 743-0396

## Contact information

- **Practice address:** 4100 RIVER RD, EAST CHINA, MI 48054-2909
- **Practice address phone:** (810) 329-7111
- **Mailing address:** 6383 GLYNDEBOURNE DR, TROY, MI 48098-2214
- **Mailing address phone:** (586) 960-5358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 4301100071 | MI | Yes |

## Other

- **Enumeration date:** 11/16/2017
- **Last updated:** 12/27/2019