Provider Demographics
NPI:1942648340
Name:CALLOWAY, KENNETH D
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:CALLOWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 LANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1152
Mailing Address - Country:US
Mailing Address - Phone:248-935-3620
Mailing Address - Fax:
Practice Address - Street 1:642 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1962
Practice Address - Country:US
Practice Address - Phone:248-547-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator