1851392427 NPI number — DR. MYRA GAIL KOLIN MD

Table of content: DR. MYRA GAIL KOLIN MD (NPI 1851392427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851392427 NPI number — DR. MYRA GAIL KOLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLIN
Provider First Name:
MYRA
Provider Middle Name:
GAIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARPER
Provider Other First Name:
MYRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851392427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36700 WOODWARD AVE
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48304-0926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-203-6620
Provider Business Mailing Address Fax Number:
248-203-0093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 W. BIG BEAVER RD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-205-3535
Provider Business Practice Location Address Fax Number:
248-649-5920
Provider Enumeration Date:
08/09/2005

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: 208000000X , with the licence number:  4301-065159 , 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: 3307137 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com