Kenneth MD PLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301100071 Issued in MI

Legal business name

KENNETH MD PLC

Practice address

4100 River Rd
East China, MI 48054-2909

Phone

(810) 329-7111

NPI assigned

Nov 16, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lynn Justusson

Title

VP

Phone

(248) 743-0396

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1831603596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6383 GLYNDEBOURNE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480982214",
            "telephone_number": "586-960-5358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 RIVER RD",
            "city": "EAST CHINA",
            "state": "MI",
            "postal_code": "480542909",
            "telephone_number": "810-329-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH MD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-16",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "JUSTUSSON",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "248-743-0396"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301100071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4301100071",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Hobbs
• Christina Janelle Horvath, RN
• Matthew Hulst, OD
• Bridget Jablinskey, MPT
• Randall Peter Kamlay, OD
• Keystone Dialysis LLC
• Charles W. Killewald, R.PH.
• Patricia Kindsvater, MD
• Lisa Sue Koehn, MSW, CSW
• Laura Lucio-Reincke, PLLC

• Internal Medicine Physician in East China, MI
• Providers in East China, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.