=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336362722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANNY KEWSON M.D. P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 05/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2454 MONROE ST STE A
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-562-4100
-----------------------------------------------------
Fax | 313-562-4590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2454 MONROE ST STE A
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48124-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-562-4100
-----------------------------------------------------
Fax | 313-562-4590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANNY KEWSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 313-562-4100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------