Healthcare Provider Details

I. General information

NPI: 1235351958
Provider Name (Legal Business Name): R. KEVIN FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

429 N BATCHEWANA ST
CLAWSON MI
48017-1368
US

V. Phone/Fax

Practice location:
  • Phone: 734-246-7380
  • Fax:
Mailing address:
  • Phone: 313-530-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301088784
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: