1245217264 NPI number — DR. KATHRYN PITONE-LIPKIN DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245217264 NPI number — DR. KATHRYN PITONE-LIPKIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITONE-LIPKIN
Provider First Name:
KATHRYN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1245217264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42557 WOODWARD AVE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48304-5206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-322-3088
Provider Business Mailing Address Fax Number:
248-322-4175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8391 COMMERCE RD STE 110B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMERCE TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48382-4489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-716-3180
Provider Business Practice Location Address Fax Number:
947-800-7270
Provider Enumeration Date:
12/30/2005

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: 207RC0000X , with the licence number:  KP012470 , 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: MI4989370 . This is a "MEDICARE GROUP PTAN ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4893235 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5472348 . This is a "BCBS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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