Individual
KEVIN SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7700
(734) 287-1953
Mailing address
2956 SAINT PAUL ST, TRENTON, MI 48183-3603
(313) 139-4687
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
MI
Other
Enumeration date
07/27/2023
Last updated
07/27/2023
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