Healthcare Provider Details

I. General information

NPI: 1487146825
Provider Name (Legal Business Name): JOHN CLAUDE KEMINK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 E 12 MILE RD
WARREN MI
48093-3570
US

IV. Provider business mailing address

12000 E 12 MILE RD
WARREN MI
48093-3570
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5101028244
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: