Healthcare Provider Details

I. General information

NPI: 1184253536
Provider Name (Legal Business Name): KAITLYN RENEE MCLEOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DRIVE 2381 CARDIOVASCULAR CENTER
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-1817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301511062
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: