Active NPI
Robert Douglas Kenewell, D.O.
- General Practice Physician
- Clinton Township, MI
National Provider Identifier
1083899850
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective May 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 5101013786
- Practice address
- 17610 Kingsbrooke Cir Apt 101
Clinton Township, MI 48038-3783 - Phone
- (586) 412-6906
- NPI assigned
- Dec 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 5101013786 | MI | Primary |
Addresses
Primary practice location
17610 Kingsbrooke Cir Apt 101
Clinton Township, MI 48038-3783
Mailing address
17610 Kingsbrooke Cir Apt 101
Clinton Township, MI 48038-3783
Phone (586) 412-6906
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101013786 | MI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198886400000",
"number": "1083899850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17610 KINGSBROOKE CIR APT 101",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480383783",
"telephone_number": "586-412-6906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17610 KINGSBROOKE CIR APT 101",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480383783",
"telephone_number": "586-412-6906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENEWELL",
"first_name": "ROBERT",
"middle_name": "DOUGLAS",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-29",
"last_updated": "2007-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "5101013786",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.