Healthcare Provider Details

I. General information

NPI: 1912103755
Provider Name (Legal Business Name): KERRI ANN BEWICK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28963 LITTLE MACK AVE STE 101
SAINT CLAIR SHORES MI
48081-3017
US

IV. Provider business mailing address

28963 LITTLE MACK AVE STE 101
SAINT CLAIR SHORES MI
48081-3017
US

V. Phone/Fax

Practice location:
  • Phone: 586-447-0700
  • Fax: 586-498-0707
Mailing address:
  • Phone: 586-447-0700
  • Fax: 586-447-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5101017315
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: