Individual
KENNETH W SHAHEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2585 CROOKS RD, TROY, MI 48084-4702
(248) 283-1110
(248) 283-1114
Mailing address
2585 CROOKS RD, TROY, MI 48084-4702
(248) 283-1110
(248) 283-1114
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2086S0122X
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2761424
—
MI
Enumeration date
08/02/2005
Last updated
07/07/2010
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