Healthcare Provider Details

I. General information

NPI: 1144966433
Provider Name (Legal Business Name): KRISTIN ANITA HILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

276 KENILWORTH ST
DETROIT MI
48202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-1023
  • Fax:
Mailing address:
  • Phone: 847-845-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351053008
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: