Provider Demographics
NPI:1982196325
Name:DANNY KEWSON M.D. P.C
Entity Type:Organization
Organization Name:DANNY KEWSON M.D. P.C
Other - Org Name:SOUTHEAST MICHIGAN EAR, NOSE AND THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-562-4100
Mailing Address - Street 1:2454 MONROE ST STE A
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3012
Mailing Address - Country:US
Mailing Address - Phone:313-562-4100
Mailing Address - Fax:
Practice Address - Street 1:2454 MONROE ST STE A
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-562-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION92880OtherMEDICARE
MI1336362722Medicaid
MION92880OtherMEDICARE