1376525717 NPI number — DONALD S KITAIN D.O.

Table of content: DONALD S KITAIN D.O. (NPI 1376525717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376525717 NPI number — DONALD S KITAIN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITAIN
Provider First Name:
DONALD
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376525717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9640 COMMERCE RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
COMMERCE TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48382-4111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-360-8825
Provider Business Mailing Address Fax Number:
248-360-8897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9640 COMMERCE RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
COMMERCE TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48382-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-360-8825
Provider Business Practice Location Address Fax Number:
248-360-8897
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  DK008753 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0456330364 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DK008753 . This is a "PHYSICIAN LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M014782 . This is a "TRICARE HEALTHNET" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0456330364 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4498389002 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01001880 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 102401 . This is a "CARE CHOICES HMO PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1876910 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4629785 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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