Individual
KEENAN TENANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
28241 GILBERT DR, WARREN, MI 48093-2625
(313) 221-3555
Mailing address
28241 GILBERT DR, WARREN, MI 48093-2625
(313) 221-3555
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703113182
MI
Other
Enumeration date
05/04/2018
Last updated
05/04/2018
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