Provider Demographics
NPI:1073791869
Name:WILLIAM L KESTENBERG MD PC
Entity Type:Organization
Organization Name:WILLIAM L KESTENBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:KESTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-539-3027
Mailing Address - Street 1:5777 W MAPLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2267
Mailing Address - Country:US
Mailing Address - Phone:248-539-3027
Mailing Address - Fax:248-932-8641
Practice Address - Street 1:5777 W MAPLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2267
Practice Address - Country:US
Practice Address - Phone:248-539-3027
Practice Address - Fax:248-932-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N86470Medicare PIN