Individual
KEVIN GINNEBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
934 ANITA AVE, GROSSE POINTE WOODS, MI 48236-1417
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/26/2020
Last updated
03/26/2020
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