Healthcare Provider Details

I. General information

NPI: 1457767030
Provider Name (Legal Business Name): KIMBERLEY MAY FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEY MAY MENEZES

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 INKSTER RD
INKSTER MI
48141-1209
US

IV. Provider business mailing address

314 INKSTER RD
INKSTER MI
48141-1209
US

V. Phone/Fax

Practice location:
  • Phone: 313-251-4722
  • Fax:
Mailing address:
  • Phone: 313-251-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49776
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: