Healthcare Provider Details

I. General information

NPI: 1659351872
Provider Name (Legal Business Name): DANNY T KEWSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 MONROE ST STE 201
DEARBORN MI
48124-3043
US

IV. Provider business mailing address

2421 MONROE ST STE 201
DEARBORN MI
48124-3043
US

V. Phone/Fax

Practice location:
  • Phone: 313-562-4100
  • Fax: 313-562-4590
Mailing address:
  • Phone: 313-562-4100
  • Fax: 313-562-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number470937495
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: