Individual
DR. KENNETH JOHN DETRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
190 KIMEL PARK DR, WINSTON SALEM, NC 27103-6946
(336) 768-3296
Mailing address
159 KESWICK DR, ADVANCE, NC 27006-7271
(336) 998-0638
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
9500884
NC
Other
Enumeration date
08/21/2008
Last updated
08/21/2008
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