Healthcare Provider Details

I. General information

NPI: 1033115944
Provider Name (Legal Business Name): KIRAN KINRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 FLUSHING RD
FLUSHING MI
48433
US

IV. Provider business mailing address

1375 FLUSHING RD
FLUSHING MI
48433-2262
US

V. Phone/Fax

Practice location:
  • Phone: 810-659-2233
  • Fax: 810-659-2246
Mailing address:
  • Phone: 810-659-2233
  • Fax: 810-659-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberKK042002
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: