Individual
MR. KENNETH THOMAS LONGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, BSN
Contact information
Practice address
14799 DIX TOLEDO RD, SOUTHGATE, MI 48195-2507
(734) 324-8326
(734) 324-8327
Mailing address
14799 DIX TOLEDO RD, SOUTHGATE, MI 48195-2507
(734) 324-8326
(734) 324-8327
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
4704129838
MI
Other
Enumeration date
09/27/2012
Last updated
09/27/2012
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