Healthcare Provider Details

I. General information

NPI: 1538976485
Provider Name (Legal Business Name): MRS. KIARA KIRKLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8163 GRAND RIVER RD STE 400B
BRIGHTON MI
48114-9422
US

IV. Provider business mailing address

24755 5 MILE RD STE 201
REDFORD MI
48239-3666
US

V. Phone/Fax

Practice location:
  • Phone: 313-200-4194
  • Fax:
Mailing address:
  • Phone: 313-200-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: