Provider Demographics
NPI:1336362722
Name:DANNY KEWSON M.D. P.C
Entity type:Organization
Organization Name:DANNY KEWSON M.D. P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
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:313-562-4590
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:313-562-4590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANNY KEWSON M.D P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4603255Medicaid
MI4603255Medicaid
MII08653Medicare UPIN