1659065019 NPI number — KREYMOHNEY DESIREE ROBINSON SPECIALIST

Table of content: KREYMOHNEY DESIREE ROBINSON SPECIALIST (NPI 1659065019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659065019 NPI number — KREYMOHNEY DESIREE ROBINSON SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
KREYMOHNEY
Provider Middle Name:
DESIREE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SPECIALIST
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:
1659065019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7081 MAPLELAWN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-1764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-598-1564
Provider Business Mailing Address Fax Number:
734-407-8783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 PEARL ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-5374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-598-1564
Provider Business Practice Location Address Fax Number:
734-407-8783
Provider Enumeration Date:
06/07/2023

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: 335E00000X , 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)





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