Individual
KENNETH JOHN DZIUBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24400 GREATER MACK AVE, SAINT CLAIR SHORES, MI 48080-1340
(586) 778-1881
(586) 778-0667
Mailing address
24400 GREATER MACK AVE, SAINT CLAIR SHORES, MI 48080-1340
(586) 778-1881
(586) 778-0667
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
KD039122
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
KD039122
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4157965
—
MI
Enumeration date
01/17/2006
Last updated
11/11/2016
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