Individual
KENNETH BISHOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
44201 DEQUINDRE RD, TROY, MI 48085-1117
(248) 964-4044
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1865
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101013989
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010F362460
BCBSM
MI
05
—
4435982
—
MI
Enumeration date
03/17/2006
Last updated
07/22/2022
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