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Individual

KENNETH J. LEVIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6777 W MAPLE RD, DEPT OF RADIATION ONCOLOGY HENRY FORD HOSPITAL, WEST BLOOMFIELD, MI 48322-3013
(248) 661-6487
(248) 661-7164
Mailing address
6777 W MAPLE RD, DEPT OF RADIATION ONCOLOGY HENRY FORD HOSPITAL, WEST BLOOMFIELD, MI 48322-3013
(248) 661-6487
(248) 661-7164

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301058146
MI
2085R0001X
Radiation Oncology Physician
Primary
4301058146
MI
2085R0203X
Therapeutic Radiology Physician
4301058146
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
488605210
MI
01
700H262300
BLUE CROSS-BLUE CROSS
01
KL058146
CHAMPUS-CHAMPUS
Enumeration date
08/24/2006
Last updated
02/06/2013
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