MEDICARE: S JEAN KEGLER 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	207N00000X	Dermatology Physician	4301039032	MI

General Provider Information

NPI Number	:	1669419750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	S JEAN KEGLER MD

Provider Business Mailing Address
First Line	:	3800 WOODWARD AVE
Second Line	:	SUITE 702
City	:	DETROIT
State	:	MI
Zip	:	48201-2061
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 E CANFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-1804
Country	:	US
Telephone Number	:	313-577-9704
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/19/2011

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