MEDICARE: KENNETH JOSEPH TOBIN DO

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	207R00000X	Internal Medicine Physician	5101011720	MI
2	207RC0000X	Cardiovascular Disease Physician	5101011720	MI
3	207RC0000X	Cardiovascular Disease Physician	25035	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700962727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH JOSEPH TOBIN DO

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	651 1ST ST W STE L
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-7046
Country	:	US
Telephone Number	:	707-935-1470
Fax Number	:

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	02/12/2026

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Directions to “ KENNETH JOSEPH TOBIN DO” Practice Location

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