Organization
KENNETH L GWINN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH L GWINN MD (PRESIDENT)
(586) 799-1212
Entity
Organization
Contact information
Practice address
48681 HAYES RD, SHELBY TOWNSHIP, MI 48315
(586) 799-1212
Mailing address
1976 MOMENTUM PL, CHICAGO, IL 60689-5319
(586) 799-1212
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
KG050974
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000009639
CAPE HEALTH
MI
01
—
0405011981
BCBS OF MICHIGAN
MI
01
—
102795880
GREAT LAKES HEALTH PLAN
MI
05
—
12795880
—
MI
01
—
131442
PREFERRED CHOICES
MI
01
—
258611
OMNICARE
MI
01
—
C7134
MCARE HMO
MI
Enumeration date
10/03/2006
Last updated
10/02/2008
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