Healthcare Provider Details

I. General information

NPI: 1982930038
Provider Name (Legal Business Name): KIMBERLY M FARROW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PETERBORO ST
DETROIT MI
48201-2722
US

IV. Provider business mailing address

6309 MACK AVE DETROIT EAST HEALTH SERVICES
DETROIT MI
48207
US

V. Phone/Fax

Practice location:
  • Phone: 313-733-1302
  • Fax: 313-309-1090
Mailing address:
  • Phone: 313-921-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number207R000000X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: