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General NPI Number Information
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NPI Number | 1407023203
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Entity Type | Organization
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Legal Business Name | ROBERT KENEWELL DO PLC
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 1380 COOLIDGE HWY
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City | TROY
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State | MI
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Zip | 48084-7069
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Country | US
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Telephone | 248-288-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 176
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City | ROYAL OAK
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State | MI
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Zip | 48068-0176
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Country | US
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Telephone | 248-288-4000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT D KENEWELL
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Credential | DO
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Telephone | 248-288-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | RK013786
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License Number State | MI
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