MEDICARE: KEVIN GINNEBAUGH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZF0201X	Forensic Pathology Physician	ME166192	FL
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301514208	MI

General Provider Information

NPI Number	:	1437786563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN GINNEBAUGH MD

Provider Business Mailing Address
First Line	:	387 KERCHEVAL AVE
Second Line	:
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48236-3020
Country	:	US
Telephone Number	:	313-570-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	387 KERCHEVAL AVE
Second Line	:
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48236-3020
Country	:	US
Telephone Number	:	313-570-5191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	05/26/2026

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