Healthcare Provider Details

I. General information

NPI: 1952434276
Provider Name (Legal Business Name): MRS. MONIQUE DENISE KELLY-PERKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 SPRINGFIELD ST
DETROIT MI
48213-3482
US

IV. Provider business mailing address

5621 SPRINGFIELD ST
DETROIT MI
48213-3482
US

V. Phone/Fax

Practice location:
  • Phone: 313-571-9315
  • Fax: 877-212-0551
Mailing address:
  • Phone: 313-571-9315
  • Fax: 877-212-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744G0900X
TaxonomyGraphics Designer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: