Healthcare Provider Details

I. General information

NPI: 1508850777
Provider Name (Legal Business Name): KENWOOD ALLERGY & ASTHMA CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30170 23 MILE RD
CHESTERFIELD MI
48047-2190
US

IV. Provider business mailing address

30170 23 MILE RD
CHESTERFIELD MI
48047-2190
US

V. Phone/Fax

Practice location:
  • Phone: 586-949-5900
  • Fax: 589-949-5922
Mailing address:
  • Phone: 586-949-5900
  • Fax: 589-949-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA A GEORGESON
Title or Position: OWNER
Credential: DO
Phone: 586-949-5900