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General NPI Number Information
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NPI Number | 1760523336
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Entity Type | Organization
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Legal Business Name | PAUL KENZIE, O.D., P.C.
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 12/22/2008
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Provider Practice Location Address
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Address Line | 108 N MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1236
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Country | US
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Telephone | 734-453-8450
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Fax | 734-453-6347
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Provider Business Mailing Address
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Address Line | 108 N MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1236
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Country | US
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Telephone | 734-453-8450
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Fax | 734-453-6347
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBRA JEAN FITZGIBBON
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Credential |
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Telephone | 734-453-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 4901002510
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License Number State | MI
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