Healthcare Provider Details

I. General information

NPI: 1992754485
Provider Name (Legal Business Name): RONALD D KERWIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 ORCHARD LAKE RD #120
WEST BLOOMFIELD MI
48322-2398
US

IV. Provider business mailing address

6330 ORCHARD LAKE RD #120
WEST BLOOMFIELD MI
48322-2398
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-3366
  • Fax: 248-855-6213
Mailing address:
  • Phone: 248-855-3366
  • Fax: 248-855-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberRK044088
License Number StateMI

VIII. Authorized Official

Name: RONALD KERWIN
Title or Position: PRESIDENT
Credential:
Phone: 248-855-3366