Individual
DR. KENNETH B GALLMORE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
28050 GRAND RIVER AVE, FARMINGTON HILLS, MI 48336-5919
(947) 521-8000
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101013600
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124004817
—
MI
01
—
700F314390
BLUE SHIELD
MI
01
—
700H219150
BLUE SHIELD
MI
Enumeration date
12/15/2005
Last updated
02/14/2022
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