Provider Demographics
NPI:1780951582
Name:D'ANDREA, KENNETH PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
Last Name:D'ANDREA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:22201 MOROSS RD
Mailing Address - Street 2:SUITE 352
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2169
Mailing Address - Country:US
Mailing Address - Phone:313-343-7747
Mailing Address - Fax:313-343-7001
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:SUITE 352
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-7747
Practice Address - Fax:313-343-7001
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2017-05-08
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Provider Licenses
StateLicense IDTaxonomies
MI5101019577207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery