Dziuba, Kenneth John
Dziuba, Kenneth John is an sole proprietor health care provider with primary practice located at 24400 Greater Mack Ave , Saint Clair Shores MI 48080-1340. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Dziuba, Kenneth John can be contacted via phone (586) 778-1881.Contact Information
Primary practice address
24400 Greater Mack Ave
Saint Clair Shores MI 48080-1340
Phone: (586) 778-1881
Fax: (586) 778-0667
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | KD039122 | Michigan |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | KD039122 | Michigan |
Profile Details
| NPI number | 1891775938 |
|---|---|
| LBN Legal business name | Dziuba, Kenneth John |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 17th, 2006 |
| Last updated | Nov 11th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891775938 | NPPES |
| Michigan | MEDICAID | 4157965 |
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