Healthcare Provider Details

I. General information

NPI: 1073141024
Provider Name (Legal Business Name): ROSS WARREN KYNAST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

33333 W 12 MILE RD STE A
FARMINGTON HILLS MI
48334-3312
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-4800
  • Fax: 248-893-6952
Mailing address:
  • Phone: 248-536-2127
  • Fax: 248-893-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301513778
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: