Provider Demographics
NPI:1912103755
Name:BEWICK, KERRI ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:ANN
Last Name:BEWICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28963 LITTLE MACK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3017
Mailing Address - Country:US
Mailing Address - Phone:586-447-0700
Mailing Address - Fax:586-498-0707
Practice Address - Street 1:28963 LITTLE MACK AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3017
Practice Address - Country:US
Practice Address - Phone:586-447-0700
Practice Address - Fax:586-498-0707
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017315207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology