Individual
DR. KENNETH L. MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Mailing address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301047387
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
440704810
—
MI
01
—
700H262290
BLUE CROSS-BLUE CROSS
—
01
—
KM047387
CHAMPUS-CHAMPUS
—
Enumeration date
12/01/2006
Last updated
03/11/2021
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